Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments

Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments. Background: No clear systematic-review on all the various treatment regimen for (Non-) cyclical-breast pain currently exists. Objectives: The aim of this study was to assess the various forms of therapy for treatment of breast-pain and the evidence for their effectiveness. Search strategy: Search-terms included 'mastalgia' and 'therapy' or 'hormones' or `nsaid' or 'psychotherapy' or 'analgesia' or 'surgery', and synonyms. Selection criteria: The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. RCT's and pro-/retrospective studies reporting on treatment of breast-pain were considered eligible. Minimal follow-up and sample-size criteria were 6 months and 10 patients respectively. Data collection and analysis: Data was extracted using standardized tables and encompassed number of subjects, type of breast-pain and treatment, efficacy of treatment and clinical complications/side-effects. No pooling of data could be achieved due to heterogeneity amongst studies. Main results: Twenty-three studies were included, that reported on 2100 patients in total. TopicalDiclofenac was found to reduce pain by 58.7 and 63.3 on a Visual-Analogue-Scale (VAS) in cyclical and non-cyclical-breast-pain respectively. Persistent cyclical-breast-pain can be treated with short courses (2-6 months) of either Bromocryptine (VAS1 = 25.4) or Danazol (VAS1 = 33.6) as long as benefits outweigh the side-effects. Last-resort options for unresponsive and severe debilitating breast-pain include surgery in the form of bilateral mastectomy with reconstruction. Conclusions: Pain reduction in patients with breast-pain can be achieved with analgesics, hormonal regimen and possibly surgery as a last resort. Additional studies are needed with well-described patient characteristics, robust study set-up, and longer follow-up times. (C) 2017 Elsevier B.V. All rights reserved.