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 .
Effectiveness of topical non-steroidal anti-inflammatory drugs in the management of breast pain.
A prospect i ve study of the effectiveness of the topical application of non-steroidal anti-inflammatory drugs ( NSAIDs ) as a gel preparation was carried out in 26 women with severe breast pain . The results showed a satisfactory relief of pain in 81 % of the women : 11 of 13 with cyclical pain , eight of 11 with non-cyclical pain , and in two women with severe scar pain after lumpectomy and radiotherapy .  Topical NSAID gel was applied as required ; the relief of severe pain was rapid and no side effects were reported . These factors compare favourably with established recommended treatments which usually involve months of continuous treatment , tailoring of drug dosages and a significant incidence of intolerable side effects . This study has shown that topical NSAID application is an effective , safe , acceptable and easily administered treatment for severe cyclical and non-cyclical breast pain
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 .