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Pain
Wendie A. Berg, MD, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Mastodynia, mastalgia, mammalgia
          • Definitions

            • Distinguish normal, nonfocal, physiologic discomfort from that which may warrant diagnostic evaluation
            • Pain is physiologic for 1-2 days prior to onset of menses
            • Visual analog scale (VAS): 10-cm scale; 0 (no pain) to 10 (pain as bad as it could be)
              • Mark intensity of pain and record measurement in cm
            • Cyclic mastalgia: Pain severity ≥ 4 cm on VAS for ≥ 7 days per month
              • Starts during luteal phase, ↑ until onset of menses then resolves
              • Does not merit imaging work-up
            • Noncyclic mastalgia: Not related to menstrual cycle; focal (1 finger can point to area of concern), persistent, merits diagnostic work-up
            • Extramammary causes of pain: Outside breast

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                • Reporting Tips

                                  Selected References

                                  1. Kushwaha AC et al: Overutilization of health care resources for breast pain. AJR Am J Roentgenol. 211(1):217-223, 2018
                                  2. Mema E et al: In the setting of negative mammogram, is additional breast ultrasound necessary for evaluation of breast Pain? Curr Probl Diagn Radiol. ePub, 2018
                                  3. Nijs J et al: Explaining pain following cancer: a practical guide for clinicians. Braz J Phys Ther. ePub, 2018
                                  4. Agasthya GA et al: Can breast compression be reduced in digital mammography and breast tomosynthesis? AJR Am J Roentgenol. 209(5):W322-W332, 2017
                                  5. Chetlen AL et al: Mastalgia: imaging work-up appropriateness. Acad Radiol. 24(3):345-349, 2017
                                  6. Cho MW et al: Focal breast pain: does breast density affect the need for ultrasound? Acad Radiol. 24(1):53-59, 2017
                                  7. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® breast pain. J Am Coll Radiol. 14(5S):S25-S33, 2017
                                  8. Feder K et al: Is Individualizing breast compression during mammography useful? - investigations of pain indications during mammography relating to compression force and surface area of the compressed breast. Rofo. 189(1):39-48, 2017
                                  9. Arslan M et al: Retrospective analysis of women with only mastalgia. J Breast Health. 12(4):151-154, 2016
                                  10. Cooney MA et al: Current knowledge of pain after breast cancer treatment: a systematic review. Pain Manag Nurs. 14(2):110-23, 2013
                                  11. Hawker GA et al: Measures of adult pain: visual analog scale for pain (VAS Pain), Numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken). 63 Suppl 11:S240-52, 2011
                                  12. Bundred NJ: Breast pain. Clin Evid (Online), 2007
                                  13. Tumyan L et al: Negative predictive value of sonography and mammography in patients with focal breast pain. Breast J. 11(5):333-7, 2005
                                  14. Smith RL et al: Evaluation and management of breast pain. Mayo Clin Proc. 79(3):353-72, 2004
                                  15. Leung JW et al: Utility of targeted sonography in the evaluation of focal breast pain. J Ultrasound Med. 21(5):521-6; quiz 528-9, 2002
                                  16. Duijm LE et al: Value of breast imaging in women with painful breasts: observational follow up study. BMJ. 317(7171):1492-5, 1998
                                  17. Fox H. Are patients with mastalgia anxious, and does relaxation therapy help? Breast. 6:138-42, 1997
                                  18. Goodwin PJ et al: Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study. Breast Cancer Res Treat. 33(1):63-73, 1995
                                  19. McNicholas MM et al: Pain and increased mammographic density in women receiving hormone replacement therapy: a prospective study. AJR Am J Roentgenol. 163(2):311-5, 1994
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Synonyms

                                            • Mastodynia, mastalgia, mammalgia
                                          • Definitions

                                            • Distinguish normal, nonfocal, physiologic discomfort from that which may warrant diagnostic evaluation
                                            • Pain is physiologic for 1-2 days prior to onset of menses
                                            • Visual analog scale (VAS): 10-cm scale; 0 (no pain) to 10 (pain as bad as it could be)
                                              • Mark intensity of pain and record measurement in cm
                                            • Cyclic mastalgia: Pain severity ≥ 4 cm on VAS for ≥ 7 days per month
                                              • Starts during luteal phase, ↑ until onset of menses then resolves
                                              • Does not merit imaging work-up
                                            • Noncyclic mastalgia: Not related to menstrual cycle; focal (1 finger can point to area of concern), persistent, merits diagnostic work-up
                                            • Extramammary causes of pain: Outside breast

                                          IMAGING

                                          • General Features

                                            • Mammographic Findings

                                              • Ultrasonographic Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              • Image Interpretation Pearls

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Kushwaha AC et al: Overutilization of health care resources for breast pain. AJR Am J Roentgenol. 211(1):217-223, 2018
                                                                  2. Mema E et al: In the setting of negative mammogram, is additional breast ultrasound necessary for evaluation of breast Pain? Curr Probl Diagn Radiol. ePub, 2018
                                                                  3. Nijs J et al: Explaining pain following cancer: a practical guide for clinicians. Braz J Phys Ther. ePub, 2018
                                                                  4. Agasthya GA et al: Can breast compression be reduced in digital mammography and breast tomosynthesis? AJR Am J Roentgenol. 209(5):W322-W332, 2017
                                                                  5. Chetlen AL et al: Mastalgia: imaging work-up appropriateness. Acad Radiol. 24(3):345-349, 2017
                                                                  6. Cho MW et al: Focal breast pain: does breast density affect the need for ultrasound? Acad Radiol. 24(1):53-59, 2017
                                                                  7. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® breast pain. J Am Coll Radiol. 14(5S):S25-S33, 2017
                                                                  8. Feder K et al: Is Individualizing breast compression during mammography useful? - investigations of pain indications during mammography relating to compression force and surface area of the compressed breast. Rofo. 189(1):39-48, 2017
                                                                  9. Arslan M et al: Retrospective analysis of women with only mastalgia. J Breast Health. 12(4):151-154, 2016
                                                                  10. Cooney MA et al: Current knowledge of pain after breast cancer treatment: a systematic review. Pain Manag Nurs. 14(2):110-23, 2013
                                                                  11. Hawker GA et al: Measures of adult pain: visual analog scale for pain (VAS Pain), Numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken). 63 Suppl 11:S240-52, 2011
                                                                  12. Bundred NJ: Breast pain. Clin Evid (Online), 2007
                                                                  13. Tumyan L et al: Negative predictive value of sonography and mammography in patients with focal breast pain. Breast J. 11(5):333-7, 2005
                                                                  14. Smith RL et al: Evaluation and management of breast pain. Mayo Clin Proc. 79(3):353-72, 2004
                                                                  15. Leung JW et al: Utility of targeted sonography in the evaluation of focal breast pain. J Ultrasound Med. 21(5):521-6; quiz 528-9, 2002
                                                                  16. Duijm LE et al: Value of breast imaging in women with painful breasts: observational follow up study. BMJ. 317(7171):1492-5, 1998
                                                                  17. Fox H. Are patients with mastalgia anxious, and does relaxation therapy help? Breast. 6:138-42, 1997
                                                                  18. Goodwin PJ et al: Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study. Breast Cancer Res Treat. 33(1):63-73, 1995
                                                                  19. McNicholas MM et al: Pain and increased mammographic density in women receiving hormone replacement therapy: a prospective study. AJR Am J Roentgenol. 163(2):311-5, 1994