Drug therapy of mastalgia. What are the options?

Severe breast pain or mastalgia is a common symptom, affecting up to 70% of the female population at some time in their lives. It accounts for approximately 50% of referrals to a specialised breast clinic, two-thirds of patients having cyclical and one-third experiencing noncyclical mastalgia, or pain arising from the chest wall deep to the breast. After exclusion of breast cancer and proper reassurance, 85% of patients can be discharged from the clinic without specific treatment. In only 15% of patients is the pain severe enough to affect their lifestyle and warrant drug therapy. Using EF-12 (gammalinolenic acid; gamolenic acid) as first-line therapy, with danazol and bromocriptine usually as second-line agents, a clinically useful improvement in pain can be anticipated in 92% of patients with cyclical and 64% with noncyclical mastalgia. Patients with severe recurrent or refractory mastalgia may require treatment with tamoxifen, goserelin or testosterone, but the short and long term adverse effects of these drugs preclude their use as first-line agents. Chest wall pain is usually self-limiting, but symptomatic relief can often be obtained using steroidal and local anaesthetic injections or nonsteroidal anti-inflammatory drugs.