In the given case the nurse should ask the following questions in addition to the ones already asked, regarding the pain. If the pain radiates to any other organ, if there is any relation between the pain and the menstrual cycle of the patient? If the pain increases before or during the menses, if there is any family history of such pains, especially in the maternal side, if anyone in the family has a history of breast cancer, or if she is pregnant or not.
Some of the important causes of breast pain which should be borne in the mind at the time of examination and relevant questions may be required to be asked in order to come to a diagnosis or reject the other probable causes. Such important causes can be, pregnancy, which is a physiological condition which may cause tenderness or pain in the breast. The pain may not be extreme, it may present as a slight discomfort of the breast. Pre menstrual syndrome may also manifest pain. It is a state prior to menses where the female may feel heaviness of the breast due to the influence of female sex hormones. Similarly, menopause can exhibit similar symptoms. It is another physiological condition where a female may feel tenderness of the breast. But breast Cancer is the most serious condition which should be ruled out first, also known as the carcinoma of breast. It is the second commonest cancer seen all over the world characterized by puckering of the breast tissue, pain, tenderness, lymphadenopathy, swelling all over or in parts over the breast, discharge, retraction of the nipples, redness, peeling and scarring of the skin of the breast, palpable lump or swelling under the arm of the affected side. Some other causes can be fibrocystic breast disease, it is a disease characterized by cystic swellings in the breast, these cysts can be hollow or fluid filled cavities.
They may enlarge before or during menses under hormonal influence, hence leading to pain occurring as a result of compression on the surrounding structures and subsequent stretching of the skin of breast. Mastitis, as the name suggests is the inflammation of the breast tissue. It may occur due to infection of the ducts of the breast; however it is not always necessary, it may result even without any apparent infection. Most commonly, it is seen in the women who are breastfeeding their infants. Intraductal papillomas are also a cause of breast pain. They are benign or non cancerous tumors arising in the milk ducts of the breast. They are composed of fibrous tissues, glandular tissues and may also contain blood vessels. They may occur in groups or may also be found to exist as a single tumor (Herndon, 2012). Some medicines may also lead to pain in the breast. These are digitalis, methyldopa, spironolactone, anadrol, chlorpromazine and some diuretics (National Breast Cancer Foundation, 2015). Fibroadenoma is again a benign tumour of the breast which may appear in groups having lobular appearance. Mostly it is painless, but very few women may complaint of pain and some tenderness (Breast Cancer Care, 2015).
Some cases of breast pain may resolve on their own without requiring any medication or treatment, whereas some may require surgical interventions. Cases of breast cancer may show the need to undergo radiotherapy or chemotherapy. The symptoms may show a cyclical pattern showing some relation with the menstrual cycle, in such cases hormonal therapy may help in treating the condition. Thus it is important to ask the patient to keep a check over the relation between the pain and the time of the monthly cycle. This can greatly help in deciding the plan of treatment. Affected patients can be asked to wear well fitting and soft bra so as to provide proper support to the breasts. Pain killers may help in some cases. The patients can be asked to reduce the intake of caffeine, saturated fats and decrease smoking (Nhs.uk, 2015).
References
Breast Cancer Care,. (2015). Fibroadenoma | Breast Cancer Care. Retrieved 9 July 2015, from https://www.breastcancercare.org.uk/information-support/have-i-got-breast-cancer/benign-breast-conditions/fibroadenoma
Herndon, J. (2012). Breast Pain: Types, Causes & Treatments. Healthline.com. Retrieved 9 July 2015, from http://www.healthline.com/symptom/breast-pain
National Breast Cancer Foundation,. (2015). Breast Pain :: The National Breast Cancer Foundation. Retrieved 9 July 2015, from http://www.nationalbreastcancer.org/breast-pain
Nhs.uk,. (2015). Breast pain - Treatment - NHS Choices. Retrieved 9 July 2015, from http://www.nhs.uk/Conditions/breastpaincyclical/Pages/Treatment.aspx
