A study done on women who received medical care through the US Veterans Administration found that fibromyalgia (and several of its known comorbidities including PTSD and IBS) was “strongly associated with frequent mastalgia”. The authors stated: “After adjustment for demographics (age, race/ethnicity, and marital status), PTSD, major depression, panic disorder, eating disorder, alcohol misuse, fibromyalgia, chronic pelvic pain, irritable bowel syndrome, and history of domestic violence each remained strongly associated with frequent mastalgia (Table 3).”  (Frequency of Mastalgia Among Women Veterans: Association with Psychiatric Conditions and Unexplained Pain Syndromes, Kay M Johnson, MD, MPH,1,2 Katharine A Bradley, MD, MPH,1,2,3 Kristen Bush, MPH,1,4 Carolyn Gardella, MD, MPH,5 Dorcas J Dobie, MD,1,6,4 and Mary B Laya, MD, MPH2 J Gen Intern Med. 2006 Mar; 21(Suppl 3): S70–S75, available in full online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513174/.)
A study by Genc et al. also found that mastalgia and fibromyalgia frequently co-exist in patients. They stated: “Fifty consecutive patients with mastalgia and 50 consecutive patients with FM were assessed and examined both for the existence and severity of mastalgia and FM. A high proportion of patients with mastalgia (36%) fulfilled the criteria for FM and 42% had mastalgia in the FM group. Two distinctive entities mastalgia and FM, being both unexplained pain syndromes, seem to frequently coexist. (Is there an association between mastalgia and fibromyalgia? Comparing prevalence and symptom severity. Genc V1, Genc A, Ustuner E, Dusunceli EB, Oztuna D, Bayar S, Kurtais Y. Breast. 2011 Aug;20(4):314-8.)
A study was done by Sen et al. (2015) of “female patients reporting breast pain during the last three months” and of “female patients diagnosed with fibromyalgia syndrome” using The Breast Pain Questionnaire. Results were as follows: “Approximately half of the patients with fibromyalgia syndrome (47.2%) reported having mastalgia at the time of admission and 37.7% of the patients with mastalgia met the diagnostic criteria for fibromyalgia syndrome. The patients with mastalgia in the fibromyalgia syndrome group had significantly higher total breast pain scores compared with the women in the mastalgia group. In addition, the patients with fibromyalgia syndrome in the mastalgia group had significantly higher Widespread Pain Index and Symptom Severity Scale scores than the patients with fibromyalgia syndrome.” They authors concluded that their findings “suggest that mastalgia can be an aspect of the central sensitivity syndrome and can be added to the somatic symptoms of fibromyalgia.” (Can mastalgia be another somatic symptom in fibromyalgia syndrome? Sen M1, Kilic MO1, Cemeroglu O2, Icen D3. Clinics (Sao Paulo). 2015 Nov;70(11):733-7, available in full online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642489/. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.)
I had the occasion to briefly discuss this case with Dr. Hugh Smythe, a fibromyalgia pioneer in Toronto, Ontario, Canada (http://www.fmperplex.com/2013/04/10/in-memoriam-hugh-a-smythe-1927-2012/). He wondered if the pain was coming from the tender point areas of the chest wall; but I assured him that pinching the fatty tissues of the upper breast was excessively painful.
She had an ongoing tension in her life and explained it saying: “I feel suspiciousness and I fear something is going to happen to me.” I took this as being indicative of a brain state that I call “danger mode”.
I once saw a woman in her late fifties who had consulted me for a severe burning pain in her left hand with numbness in her left arm. She also had pains in her left breast. Her gastroenterologist had diagnosed her with irritable bowel syndrome (which is known to be common in fibromyalgics). She also had a history of restless leg syndrome, snoring and occasional hypnic jerks. She suffered from nightmares about 6 times a month.
She told me the numbness had been going in her left arm for about a year. Three years prior she had been diagnosed with fibromyalgia. She had morning stiffness for about an hour a day. She lacked stamina and could never walk longer than for thirty minutes or stand for more than an hour. She was tender over the back of her neck and her lower back, as well as over her upper chest and right down her left arm. She said her sleep was poor because, in her words of “pain and thinking the worse”. Her fibromyalgia symptoms and irritable bowel symptoms tended to flair at the same times.
She complained bitterly of numbness and pain in her left arm and hand. Numb-ness in the limbs is common in fibromyalgics. She described the pain in her left hand as being like “fire” or “flame” and “very disturbing”. She held her left hand in such a way as to try to sooth it with her right hand. She said “I feel like something walks on my skin.” She said: “My finger tips are numb.”
Her trigger point exam showed 16/18 positive sites. She also had numerous moderately tender control points. These were not as tender as the known trigger points. I was left with the impression of generalized soft tissue tenderness.
I assessed her skin and soft tissues by doing the skin fold rolling test on her pain, and it was clearly quite sore. Many fibromyalgics have no pain when this is done, and it is suggestive of a problem in sensation for the skin or fat below it.
Her left breast was very sore. The upper portion was very tender on physical exam. She then explained that this pain had been studied a number of times in the past. Several past mammograms had been normal. I wondered if her breast pains might be part of her fibromyalgia. I also wondered how common it was and if doctors might be ordering unnecessary mammograms, and creating anxious days while patients wait for their results while hoping it is not cancer.