RESULTS Reassurance plus bra-fitting advice provides relief for most women .
There is some benefit in reducing dietary coffee and fat intake .
Dopamine agonists are useful , but less effective than endocrine treatments such as Danazol or Tamoxifen .
Of the Selective Oestrogen Receptor Modulator drugs , Ormeloxifene appears most effective , but is not licenced in the United Kingdom .
Relaxation therapy , acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness .
Subsequent drug therapy should be balanced against its side-effects ; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects .
INTRODUCTION Idiopathic mastalgia ( benign breast pain of unknown origin ) is often poorly managed because of its subjective nature and unclear aetiology .
Mastalgia is a reason for up to 50 % of breast outpatient referrals .
Existing systematic review s discuss date d treatment options that provide limited symptomatic relief .
Clinical evaluation of mastalgia.
OBJECTIVE To describe an accurate and reproducible method to quantify a patient 's subjective experience of breast pain .  DESIGN Prospect i ve diary study . SETTING Military tertiary care hospital . PATIENTS Thirty female military health care beneficiaries from the Walter Reed Army Medical Center , Washington , DC , gynecology and general surgery clinics . MAIN OUTCOME MEASURES Daily mastalgia was recorded using a visual analog scale and menstrual symptoms were measured using a daily question naire . These measures were correlated with results of a screening question naire completed prior to study entry . RESULTS Patients identified as having cyclical mastalgia based on the  screening question naire ( n= 15 ) were found to have higher peak perimenstrual mastalgia according to their daily diaries than patients who did not meet diagnostic criteria ( n=15 ) ( 5.3+/-0.7 vs 3.5+/-0.5 , P<.001 ) . Applying the same criteria used in the screening question naire to the diary data , 17 of 30 patients met diagnostic criteria for cyclical mastalgia . The ability of the screening question naire to predict the results of the prospect i ve diary data was calculated , and positive and negative predictive values were 73 % and 60 % , respectively . Most patients with cyclical mastalgia also have other perimenstrual psychological and somatic complaints , although a subset of patients has high levels of mastalgia with minimal associated symptoms . CONCLUSIONS Accurate assessment of mastalgia can not be done with a retrospective question naire and requires prospect i ve diary evaluation , owing to the variable and subjective nature of symptoms and recall bias . A daily visual analog scale provides reproducible results and is easy for patients to use
RESULTS Reassurance plus bra-fitting advice provides relief for most women .
There is some benefit in reducing dietary coffee and fat intake .
Dopamine agonists are useful , but less effective than endocrine treatments such as Danazol or Tamoxifen .
Of the Selective Oestrogen Receptor Modulator drugs , Ormeloxifene appears most effective , but is not licenced in the United Kingdom .
Relaxation therapy , acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness .
Subsequent drug therapy should be balanced against its side-effects ; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects .
INTRODUCTION Idiopathic mastalgia ( benign breast pain of unknown origin ) is often poorly managed because of its subjective nature and unclear aetiology .
Mastalgia is a reason for up to 50 % of breast outpatient referrals .
Existing systematic review s discuss date d treatment options that provide limited symptomatic relief .