Breast Pain
From the American College of Radiology
"The etiology of breast pain is not well understood and is probably multifactorial. Several possible causes have been studied, particularly for cyclical mastalgia, including a disturbance of hypothalamic control, abnormal hormonal response to stimuli, abnormal end-organ sensitivity, altered local hormone receptors, and disorders of lipid metabolism/fatty acid levels (which may result in exaggerated effects of normal levels of hormones). Hormonal medications, including hormone replacement therapy, oral contraceptives and infertility treatments, can be a cause of breast pain and tenderness. Other medications are also frequently implicated, specifically the selective serotonin reuptake inhibitor form of antidepressants. Psychological factors may also be involved. Studies indicate no direct relationship between mastalgia and fibrocystic changes or total-body water retention. There is no convincing scientific evidence that eliminating or reducing caffeine intake has any significant effect on breast pain, despite widespread belief to the contrary. Breast pain can be associated with diffuse palpable nodularity, but there is no relationship between the extent of nodularity and the severity of pain [10]. Twenty-five percent of patients with noncyclical pain are reported to have duct ectasia with periductal inflammation, characterized by an exquisite continuous burning pain, usually behind the nipple, and a hypersensitive breast [14,18]. This entity is often associated with heavy smoking. Women with large breasts often have noncyclical pain simply related to the size of their breasts, which may also be associated with neck, shoulder, and back pain.”
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