The algorithm also addresses pharmacologic approaches for debilitating and nondebilitating breast pain.15-22 A short course of a scheduled oral nonsteroidal anti-inflammatory medication can improve breast comfort.

Anecdotally, addition of daily omega-3 has shown beneficial anti-inflammatory effects. Fish oil (1,000 to 1,200 mg daily) is an easily accessible and cost-effective option. An old study suggests that oil of evening primrose can significantly diminish cyclic breast pain,23 but four additional studies have found no evidence of benefit.24-27 Furthermore, this treatment requires frequent dosing and is prohibitively expensive.

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The associated side effects of the various pharmacologic approaches to the management of breast pain make them a less appealing option for patient and clinician alike.

Extra-mammary pain falls in the category of myofacial or musculoskeletal pain (Table 1). Such referred pain is treated by managing the underlying cause. Strategies can include referral to a pain-management specialist for steroid injections, topical analgesic application, and oral therapies.28

Because the etiology of breast pain is multifactorial, the clinical management is fluid in nature. Many management strategies take time to work. We routinely have women return for re-evaluation in three to six months. Additional research investigating causation of breast pain and new techniques for breast-pain management is warranted.

Glenda Bell Flynn, FNP-C, AOCNP, and Catherine Tipton, MSN, FNP-BC, are family nurse practitioners at Baystate Surgical Oncology’s Comprehensive Breast Center in Springfield, Mass.


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All electronic documents accessed September 15, 2011.