What initial management strategies are recommended for patients presenting with mild to moderate breast pain?

For patients presenting with mild to moderate breast pain, the initial management strategies focus on reassurance, supportive measures, and simple pain relief.

• Reassurance and Information: Reassure the patient that there is no serious underlying pathology ¹. Offer written patient information on cyclical breast pain, such as the 'Breast pain' resource available on the NHS website ¹.
• Supportive Bra: Advise the patient to wear a well-fitted bra during the day, a more supportive bra during exercise, and a soft support bra at night ¹.
• Analgesia: Recommend oral paracetamol and/or ibuprofen, or a topical nonsteroidal anti-inflammatory preparation, as required ¹. Paracetamol and ibuprofen are also recommended for symptomatic relief in cases of mastitis ²,³.
• Pain Diary: Encourage the patient to keep a pain diary to help evaluate the severity and timing of the pain, and its response to treatment ¹.
• Symptomatic Relief (if mastitis is a consideration): Advise the use of cold compresses on the breast, or bathing or showering in warm water, to help relieve pain ²,³.
• Treatments Not Routinely Recommended: It is important to note that treatments such as evening primrose oil, flaxseed, diets low in fat or caffeine, Vitamin B6, Vitamin E, and stopping or changing contraceptives are not routinely recommended due to limited or contradictory evidence ¹.