Refractory mastalgia or inadequately treated mastalgia?

Background: Though mastalgia is a common problem standard algorithms of management are not always followed by clinicians. Inadequately treated mastalgia arises as a consequence. This is labelled as refractory mastalgia and referred to breast clinics for further treatment.
Aims: To determine whether instances of mastalgia labelled as refractory were truly refractory to treatment or whether they were merely instances of inadequate treatment, by observing their response to non-pharmacological treatment.
Settings and Design: A prospective observational study was undertaken in an outpatient breast clinic setting.
Material and Methods: Fifty-eight patients with "refractory" mastalgia were evaluated. Treatment was by reassurance, low-fat, methyl xanthine restricted diet and dietary supplementation with 500 mg/day of evening primrose oil. Response to treatment was assessed at three and six months. Statistical analysis used: Frequency, cross tabulations and 95% CI were determined by a professional statistical software package (SPSS).
Results: There was a 94.3% overall response to non-pharmacological treatment, which indicated that they were all instances of inadequately treated mastalgia and not refractory mastalgia.
Conclusion: Instances of mastalgia are being labelled as refractory without acknowledging inadequacy of treatment.

Keywords
Refractory mastalgia, Inadequately treated mastalgia, Standard algorithms of Mastalgia management