Analgesic Efficacy of Pulsed Radiofrequency in Non-cyclic Mastalgia

Introduction:

Breast pain, mastalgia or mastodynia, is recognized as an organic benign breast disease . It can be severe enough to cause disturbances in normal quality of life rating which leads to disorders in sexual, physical, and social activities. When compared with other conditions, it will be similar to chronic cancer pain in the mean pain-index .

Breast pain is classified into three main categories: cyclical, non-cyclical and extra-mammary mastalgia. Cyclical pain is the commonest and it has a temporal association with the menstrual cycle. Pain characteristically starts in the days before menstruation and gradually increases. It tends to subside once menstruation has started and often disappears after a few days. Pain in these women usually abates after the menopause. These factors suggest a hormonal aetiology, high level of estrogen, low level of progesterone, and imbalance in estrogen to progesterone ratio are assumed among its causes, as well. Furthermore, many women associate the onset and resolution of cyclical mastalgia with a hormonal event, such as pregnancy or taking the oral contraceptive pill .

In contrast, there is no relationship to the menstrual cycle with non-cyclical mastalgia. Non-cyclic breast pain may result from pregnancy, mastitis, trauma, thrombophlebitis, macrocysts, psychologic disturbance, benign tumors, or cancer. However, only a minority of breast pain is explained by these conditions. Most non-cyclic breast pain arises for unknown reasons. Typically, it presents at a later age; most women are in the fourth or fifth decade of life at diagnosis. Many women are postmenopausal at onset of symptoms. Unfortunately, the course of both cyclical and non-cyclical mastalgia may be long and last many years.

The origin of extra-mammary pain is variable. Referred pain from cardiac, pulmonary and gastrointestinal causes, such as angina, pneumonia and oesophagitis, respectively, need to be excluded. A common cause of extra-mammary mastalgia arises from inflammation of the costochondral junctions of the chest wall (Tietze's disease). This condition usually resolves with rest and non-steroidal anti-inflammatory drugs .