New Breast Pain Chart for Objective Record of Mastalgia

Abstract

Mastalgia is the commonest affliction of mammary gland among ladies of the reproductive age group. Since etiopathogenesis and therapy are different for cyclical and noncyclical pain, it is imperative to ascertain the exact type correctly. This is usually done in the breast clinics by advising the patient to fill a pain diary over a period of 2 months over two menstrual cycles. The Cardiff pain chart records the severity of pain in the form of a triangle for mild to moderate pain and a square for severe pain. Moreover, Cardiff pain chart does not allow a patient to record the severity of pain on days of menses, as she has to put the letter “P” in the box. These problems have been resolved in the new breast pain chart. In the new pain chart, the lady records pain severity in the form of visual linear analogue scale score on every day of menstrual cycle. She enters her menstrual experience on a separate part of chart, which allows us to visualize the full month’s pain severity in an uncluttered way.

Background

Mastalgia is the commonest affliction of mammary gland among ladies of the reproductive age group. There are two patterns of breast pain; cyclical and non-cyclical. The cyclical pain is associated with occurrence of breast pain about 1 to 2 weeks prior to menstruation relieved by the onset of menstrual flow. The pain is usually felt diffusely in both the mammary glands, often with tenderness and nodular feeling of the mammary parenchyma called nodularity. The etiology of cyclical mastalgia is considered to be a disturbance in hormonal balance between estrogen, progesterone, prolactin, and the responsiveness of target organs to these hormones. This type of breast pain responds better to hormonal manipulation viz. antiestrogen agents (like Tamoxifen and Centchroman), Danazol, and LHRH analogue [1].

The non-cyclical mastalgia can occur at any time in relation to menstrual cycle or be present throughout the month. It may be felt either in one or both breasts. The pain may be located to a particular point which when touched leads to sharp severe pain- called “trigger point pain.” The non-cyclical mastalgia does not have a hormonal basis and is associated either with an inflammation like periductal mastitis, infections, tuberculosis, and tumors or scarring of surgery or inflammation viz. sclerosing adenosis. The non-cyclical pain may occur due to an inflammation of musculoskeletal system around the mammary glands like costochondritis (Teitz’s syndrome) [1].

Since etiopathogenesis and therapy are different for cyclical and non-cyclical pain, it is imperative to ascertain the exact type correctly. This is usually done in the breast clinics by advising the patient to fill a pain diary over a period of 2 months over two menstrual cycles. Most breast clinics use a pain chart similar to one devised at Cardiff Mastalgia clinic (Fig. 1). In this pain chart, the lady fills her experience on a day-to-day basis. There is provision of recording the severity of pain by either marking the box as “full” square for severe pain or “half” triangle for mild to moderate intensity pain. She records the days of menses with letter “P” on the chart. Hence, the pain severity is not clearly depicted on the days of menses, as she has to put the letter “P” in the box. Moreover, the visual linear analogue or VLA (Fig. 2) scores for every day are not recorded in Cardiff chart. We usually ask the lady about overall experience over a month’s period [2]. Here, we present a more objective way of recording VLA score on a “day-to-day” basis.

Fig. 1.

Old breast pain chart (Cardiff breast pain chart)

Fig. 2.

Visual linear analogue scale

The New Pain Chart Recording

A lady health worker provides the lady with explanation about filling the chart (Fig. 3). The patient is requested to record her pain experience in terms of VLA score of “0” to “10.” The lady fills a numeric value say “9” or “10” if pain is very severe. If she has no pain on next day, she fills a value of “0” on that day. Similarly, the VLA score of each day of the menstrual cycle is recorded. In the lower part of the chart, the menstrual history is recorded on a day-to-day basis. This recording of menstrual experience separately allows us to visualize the pain severity on days during menses in an uncluttered way.

Fig. 3.

New breast pain chart

Benefits of New Day-to-Day VLA Scores Recording

This record of VLA scores enables us to:

1. Mensuration of severity of pain on a day-to-day basis, before, after, and during menstruation.

2. It allows us to record pain of each breast separately.

3. The objective measurement of total pain score over the whole month. The scores of a full month can be summated and its mean, median, standard deviation, or 95 % confidence interval can be computed. This objective recording and mensuration of breast pain with separate explicit recording of menstruation before and after therapy with a drug is going to be particularly beneficial in the conduct of randomized trials on therapy of mastalgia. It will also allow exact record of “alteration of menses” with hormonal agents viz. Centchroman, Tamoxifen, Danazol, and LHRH analogues.

Compliance with Ethical Standards

Funding

None

Presentation or prior publication

None

Conflict of Interest

The authors declare that they have no conflict of interest.