STUDY - Technical - New Dacian's Medicine
breast
pain (Classical / Allopathic Medicine)
An unreliable
indicator of cancer, breast pain commonly results from benign
breast disease. It may occur during rest or movement and may
be aggravated by manipulation or palpation. (Breast tenderness
refers to pain elicited by physical contact.) Breast pain may
be unilateral or bilateral; cyclic, intermittent, or constant;
and dull or sharp. It may result from a surface cut, a
furuncle, a contusion, or a similar lesion (superficial pain);
a nipple fissure or inflammation in the papillary duct or
areola (severe localized pain); stromal distention in the
breast parenchyma; or a tumor that affects nerve endings
(severe, constant pain). Breast pain may radiate to the back,
the arms, or the neck.
Breast tenderness
in women may occur before menstruation and during pregnancy.
Before menstruation, breast pain or tenderness stems from
increased mammary blood flow due to hormonal changes. During
pregnancy, breast tenderness and throbbing, tingling, or
pricking sensations may occur, also from hormonal changes. In
men, breast pain may stem from gynecomastia (especially during
puberty and senescence), a reproductive tract anomaly, or an
organic disease of the liver or the pituitary, adrenal cortex,
or thyroid gland.
HISTORY:
Ask the patient about the breast pain's onset and character. Is it constant or intermittent? If it's intermittent, determine the relationship of pain to the phase of the menstrual cycle.
Ask the patient to describe the pain. Determine if the pain affects one breast or both, and ask her to point to the painful area.
Ask the patient if she's lactating. If not, ask her if she's experiencing nipple discharge. If so, have her describe it.
Ask the patient if she's pregnant, uses a hormonal contraceptive, or has reached menopause.
Ask the patient if she recently experienced flulike symptoms or a sustained injury to the breast. Has she noticed any change in breast shape or contour?
Ask the patient about the breast pain's onset and character. Is it constant or intermittent? If it's intermittent, determine the relationship of pain to the phase of the menstrual cycle.
Ask the patient to describe the pain. Determine if the pain affects one breast or both, and ask her to point to the painful area.
Ask the patient if she's lactating. If not, ask her if she's experiencing nipple discharge. If so, have her describe it.
Ask the patient if she's pregnant, uses a hormonal contraceptive, or has reached menopause.
Ask the patient if she recently experienced flulike symptoms or a sustained injury to the breast. Has she noticed any change in breast shape or contour?
PHYSICAL
ASSESSMENT:
Instruct the patient to place her arms at her sides, and then inspect her breasts. Note their size, symmetry, and contour as well as the appearance of the skin.
Note the size, shape, and symmetry of the nipples and areolae. Do you detect ecchymosis, a rash, ulceration, or a discharge? Do the nipples point in the same direction? Do you see signs of retraction, such as skin dimpling or nipple inversion or flattening? Repeat your inspection, first with the patient's arms raised above her head and then with her hands pressed against her hips.
Palpate the breasts, first with the patient seated and then with her lying down and a pillow placed under her shoulder on the side being examined. Note any warmth, tenderness, nodules, masses, or irregularities.
Palpate the nipples, noting tenderness and nodules, and check for discharge.
Palpate axillary lymph nodes, noting any enlargement.
Instruct the patient to place her arms at her sides, and then inspect her breasts. Note their size, symmetry, and contour as well as the appearance of the skin.
Note the size, shape, and symmetry of the nipples and areolae. Do you detect ecchymosis, a rash, ulceration, or a discharge? Do the nipples point in the same direction? Do you see signs of retraction, such as skin dimpling or nipple inversion or flattening? Repeat your inspection, first with the patient's arms raised above her head and then with her hands pressed against her hips.
Palpate the breasts, first with the patient seated and then with her lying down and a pillow placed under her shoulder on the side being examined. Note any warmth, tenderness, nodules, masses, or irregularities.
Palpate the nipples, noting tenderness and nodules, and check for discharge.
Palpate axillary lymph nodes, noting any enlargement.
SPECIAL
CONSIDERATIONS:
Provide emotional support for the patient and, when appropriate, emphasize the importance of monthly self-examination.
Provide emotional support for the patient and, when appropriate, emphasize the importance of monthly self-examination.
PEDIATRIC
POINTERS:
Transient gynecomastia can cause breast pain in males during puberty.
Transient gynecomastia can cause breast pain in males during puberty.
AGING ISSUES:
Breast pain secondary to benign breast disease is rare in postmenopausal women.
Breast pain can result from trauma, either from falls or physical abuse.
Because of decreased pain perception and decreased cognitive function, an elderly patient may not report breast pain.
Breast pain secondary to benign breast disease is rare in postmenopausal women.
Breast pain can result from trauma, either from falls or physical abuse.
Because of decreased pain perception and decreased cognitive function, an elderly patient may not report breast pain.
PATIENT
COUNSELING:
Advise the patient to wear a brassiere that cups and supports the entire breast with wide shoulder and back straps. Tell the patient that warm or cold compresses may aid pain relief.
Advise the patient to wear a brassiere that cups and supports the entire breast with wide shoulder and back straps. Tell the patient that warm or cold compresses may aid pain relief.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)