Therapeutic Effects of Vitamin E on Cyclic Mastalgia

Does atorvastatin have augmentative effects with sodium valproate in prevention of migraine with aura attacks? A triple-blind controlled clinical trial

Background

Migraine is a painful and disabling nervous disorder which negatively affects the quality of life. Migraineurs may suffer from a generalized vasomotor dysfunction. Statins improve vasomotor and vascular function, with their pleiotropic effects. We aimed to assess efficacy and safety of adding Atorvastatin to prophylactic regimen in better control of migraine with aura.

Methods

This triple-blind controlled clinical trial was on 68 patients with migraine with aura. An interval of at least 1 month was given to evaluate vitamin D3 level and eligibility. In patients with vitamin D3 deficiency, the correction with vitamin D supplementation was provided. The patients were randomly assigned to receive atorvastatin 20 mg plus sodium valproate 500 mg or placebo plus sodium valproate 500 mg once a day for 2 months. The patients were evaluated based for the number of attacks and pain severity based on Visual Analogue Scale.

Results

There was a significant (p = 0.0001) improvement in severity of pain and number of migraine attacks by adding Atorvastin to the prophylactic regimen of patients with migraine with aura. After controlling for variable parameters, the differences between two arms of the study was yet statistically significant (p = 0.0001). A significant number of participants in intervention group were satisfied by their treatment (p = 0.001) with no remarkable side effects (P = 0.315).

Conclusions

Adding atorvastatin to migraine with aura preventive regimen may help reduce the number of acute attacks and pain severity without causing considerable side effects and led to a better patient satisfaction.

Trial registration

IRCT20180106038242N1. Registered: 7 February 2018.

Assessment of motor skill accuracy and coordination variability after application of local and remote experimental pain

Motor learning is a relatively permanent change in motor performance. Also, one of the factors that can affect movement acquisition and movement patterns is pain and injury. The present study aims to investigate the effect of the induced local and remote pain during dart-throwing skill acquisition by examining motor skill accuracy and coordination variability. Three groups of 30 participants with a mean age of 18-25 were randomly assigned to local and remote pain or control groups. Capsaicin gel was applied to the pain groups for measuring the severity of pain using the Visual Analogue Scale (VAS). The results revealed that pain had no impact on dart-throwing skill acquisition, and there was no significant difference (p = 0.732) among the three groups at three stages of retention test. The results also showed that there was a significant difference among the three groups in terms of variability in shoulder-elbow (p = 0.025) and elbow-wrist joints (p = 0.000) in the deceleration and dart-throwing phases. The Central Nervous System seems to make adjustments when the task is associated with pain during the acquisition phase. Also, the groups with or without pain have notably various strategies, so differently, to perceive motor skills.

The Effect of Healthy Lifestyle Promotion Intervention on Quality of Life in Cyclic Mastalgia via Individual Counseling: A Randomized Controlled Clinical Trial

Background

Despite high number of visited cases, there are no certain therapeutic guidelines for mastalgia. Generally pain is associated with poor quality of life in all dimensions. The present study aimed to investigate the effect of healthy lifestyle promotion intervention on the quality of life in cyclic mastalgia.

Methods

This study was a randomized controlled trial (RCT) conducted on women suffering from cyclic mastalgia at the age of 20 and older before menopausal age referred to the health centers of Karaj,Iran from September 2017 to August 2018. The participants were randomly assigned to intervention (N=40) and control groups (N=40). Intervention was carried out in two 46-minute sessions and two 90-minute sessions for the intervention group. The quality of life was assessed before and after the intervention in both groups using the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The data were analyzed through SPSS statistical software(version 21) using independent sample t-test, Chi-square,and Paired t-test. Besides, P<0.05 was considered as statistically significant.

Results

Before the intervention, both groups were matched in terms of marital status, educational level, occupation, history of breastfeeding, and mean scores of quality of life (P>0.05). After the intervention, the mean score of life quality in physical, social, environmental, and general health dimensions in the intervention group increased significantly compared to the control group (P&gt;0.001). This difference was not statistically significant in the mental health dimension (P=0.086).

Conclusion

The present study indicated that healthy lifestyle promotion intervention could improve the quality of life of women with cyclic mastalgia.Trial Registration Number: IRCT2017100236513N1.

Evaluation of mastalgia in patients presented to the breast clinic in Duhok city, Iraq: Cross sectional study

INTRODUCTION

Mastalgia is a common condition that may affect up to two-thirds of patients during the reproductive period. It can be divided into cyclical and noncyclical. It is mostly due to benign causes, but breast cancer should be excluded. It may be associated with a high level of stress and anxiety. Patients need to be assessed fully, breast and general examinations, and investigations such as breast imaging and hormonal assay.

PATIENTS AND METHODS

This is a prospective study that was done in the breast clinic in the period between February 2019 and July 2019. A total number of 445 patients with mastalgia included were in the study. Patients were examined and evaluated using various imaging modalities.

RESULTS

The mean age of the patients was 34 years. Mastalgia was present in 54.2% of our patients, in about 70.1% of our patients it was noncyclical mastalgia. Mastalgia was positively correlated with smoking, oral contraceptive pills, and positive family history of breast cancer (p values: 0.000, 0.009, and 0.000) respectively with no correlation with other factors. The type of pain was less in women having early first pregnancy and with the site of the pain showed a positive correlation with the type of pain, (p values: 0.001 and 0.000) respectively.

CONCLUSION

Mastalgia is a common complaint which may affect most females. It is caused by benign breast disorders in the majority of patients. A systematic approach must be followed for the management of mastalgia. Reassurance, regular exercise, and local analgesics may be very effective initial measures. In severe, intractable cases, hormonal therapy may be used.

Effect of vitamin E on severity and duration of cyclic mastalgia: A systematic review and meta-analysis

OBJECTIVES

A systematic review was conducted to assess the effect of vitamin E on the severity and duration of Cyclic Mastalgia compared to vitamin B6, fish oil, herbal medicines and placebo.

DESIGN

A systematic review and meta-analysis of clinical trials.

METHODS

A search was carried out in PubMed, Cochrane Library, Embase, Scopus and Google Scholar and Persian databases for articles published from 1980 to 2018. The data obtained were analyzed in RevMan and reported in forest plots. The Odds Ratio (OR) was used to find the effect for the dichotomous data and the Standardized Mean Difference (SMD) for the continuous data. The heterogeneity of the studies was assessed using I² and the Random Effects Model was used instead of the Fixed Effects Model if I²>25%.

RESULTS

A total of 1051 titles and abstracts were extracted. Fourteen articles ultimately remained, and 11 of them were entered into the meta-analysis. The meta-analysis showed significant differences between vitamin E and placebo in the severity (SMD=-0.51; 95% CI=-0.21 to -0.82) and duration (MD=-1.47; 95% CI=-0.91 to -2.57) of cyclic mastalgia, although herbal medicines had a greater effect on the severity of mastalgia than vitamin E (SMD = 0.51, 95% CI = 0.06 to 0.96).

CONCLUSION

Although herbal medicines are more effective than vitamin E, vitamin E reduces both the severity and duration of the disorder compared to placebos, which only reduce its severity, and can therefore be considered a treatment with minimum side-effects. Due to the high heterogeneity of the studies, the researchers recommend further research on the subject using a standard tool based on the CONSORT statement.

Clinical management of idiopathic mastalgia: a systematic review

ABSTRACT INTRODUCTIONIdiopathic 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 reviews discuss dated treatment options that provide limited symptomatic relief. METHODSA systematic review was conducted for aetiology and treatment of idiopathic mastalgia in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Databases such as PubMed, MEDLINE, Cochrane Database and the Clinical Trial Registry were searched (February 2016). RESULTSReassurance plus bra-fitting advice provides relief for most women. If symptoms persist, addition of topical non-steroidal anti-inflammatory drugs (NSAIDs) provides relief in 70–92% of women. There is some benefit in reducing dietary coffee and fat intake. Medical treatments have serious side-effects (often androgenic or menopausal) and should be considered only in cases resistant to simpler measures. 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. DISCUSSIONFirst-line management of breast pain should be explanation, reassurance and a bra-fitting advice. Subsequent drug therapy should be balanced against its side-effects; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects. Newer agents (Ormeloxifene) currently being used for mastalgia in India could be considered in the developed world.

The evaluation of the effect of metformin on breast fibrocystic disease

BACKGROUND

Fibrocystic changes (FCC) is the most common benign breast disease. The main pathophysiologic mechanism of FCC, excessive cell proliferation in response to monthly estrogen and progesterone changes. Regarding to antiproliferative of metformin, the aim of this study is the evaluation of the effect of metformin on FCC in women who were referred to gynecology clinics of ArakMETHODS:This study is a double blind placebo control randomized clinical trial. At the first among women who were referred to gynecology of Arak, 186 women with FCC between 18-40 years were selected. The women were randomly classified into three groups. The first group took metformin and the second group as placebo group took vitamin E and the third group did not take any drug during six months. All groups were compared in clinical symptoms based on visual analogue scale (VAS) and the sonographic data also were recorded and compared. Data analysis was performed by unilateral variance, student t and Chi-square.

RESULTS

The three groups were not different in aspect of mean of the cysts number, cyst size, tenderness and discharge from breast before the intervention, but after the intervention, there was a significant decrease in metformin group (p value < 0.001) based on variance analysis test. There was not a meaningful difference of pain and the location of cysts between the groups after the intervention.

CONCLUSIONS

The present study showed that metformin is effective in treatment of FCC and decreasing of clinical symptoms and imaging items.

Clinical effectiveness of vitamin E and vitamin B6 for improving pain severity in cyclic mastalgia

Background:

Recent attempts have been focused on employing chemical and natural supplemental agents for treatment of cyclic mastalgia. Among various agents, the potential effects of vitamins remain questionable. In the present study, we examined the efficacy of two types of these vitamin supplements (vitamin E and vitamin B6) in improving pain severity in cyclic mastalgia.

Materials and Methods:

In a randomized double-blinded clinical trial, 80 patients suffering from cyclic mastalgia were randomly assigned to receive 200 IU of vitamin E daily or 40 mg/day of vitamin B6 for 2 months. Written informed consent was obtained from all participants. Severity of breast pain was detected by the Cardiff breast pain score during one menstrual cycle before and two menstrual cycles after the intervention. Data were analyzed using t-test, Chi-squared test, analysis of variance (ANOVA), and regression with SPSS version 19 and P < 0.05 was considered significant.

Results:

There was no significant difference in the mean of severity of cyclic mastalgia during one menstrual cycle before the intervention between the vitamin E and B6 groups (9.1 ± 2.1 and 8.4 ± 3.1, respectively), but the difference was significant during the first cycle (5.1 ± 1.6 and 5.2 ± 2.5, respectively) and the second menstrual cycle (2.3 ± 1.0 and 2.6 ± 2.0, respectively) in the two groups after the intervention. The trend of changes in pain severity score showed significant downward trend of pain severity score within the study period in both the treatment groups (P < 0.001), while these trends were similar in both groups when examined by the repeated-measure ANOVA test. By multivariable linear regression analysis adjusted for baseline variables, we found that both the treatment regimens resulted in similar reduction in breast pain severity (P = 0.067).

Conclusions:

Both regimens containing vitamin E and vitamin B6 are similar in reducing breast pain severity in cyclic mastalgia.

Effects of Vitex agnus and Flaxseed on cyclic mastalgia: A randomized controlled trial

OBJECTIVES

Evidence on the effect of Vitex agnus and Flaxseed on cyclical mastalgia is not enough. This study aimed to assess the efficacy of V. agnus and Flaxseed on cyclical mastalgia.

DESIGN AND SETTING

This randomized controlled trial was conducted on 159 women referred to health centers of Tabriz, Iran. Subjects were allocated into three groups (n=53 per group) using block randomization.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Group I received 25g daily Flaxseed powder and placebo of V. agnus; group II received daily 3.2-4.8mg V. agnus tablet and placebo of Flaxseed and control group received both placebo. Nominal day breast pain was applied at baseline, first, and second month after the intervention. Data was analyzed using general linear model.

RESULTS

There was no statistical significant difference between the three groups in terms of socio-demographic characteristics and baseline values. The breast pain improved significantly in both intervention groups during the first and second month after intervention. Mean NDBP score was significantly lower than that in the control group at the first month after the intervention in the Flaxseed [adjusted mean difference: -3.1 (95% CI: -4.2 to -2.0)] and V. agnus groups [-3.3 (-4.3 to -2.2)] and the second month after the intervention in Flaxseed [-7.0 (-8.1 to -5.9)] and V. agnus groups [-6.4 (-7.5 to -5.3)].

CONCLUSION

Flaxseed and V. agnus are effective in short-term period in decreasing cyclical mastalgia. However, further studies are needed to examine the long-term effectiveness and sustainability of the effects after stopping the treatment in order to decide whether these alternative treatments are suitable to treat mastalgia or not.

Comparing the effects of dietary flaxseed and omega-3 Fatty acids supplement on cyclical mastalgia in Iranian women: a randomized clinical trial

Considering the negative side effects of chemical drugs, there is a great need for effective alternative treatment strategies to manage cyclical mastalgia. Therefore, this study aimed at comparing the effects of flaxseed diet and omega-3 fatty acids supplement on treatment of cyclical mastalgia. In this study, 61, 60, and 60 women, respectively, received flaxseed as bread, omega-3 fatty acids as pearl, and wheat bread as their diet for two menstrual cycles. At the baseline cycle and end of both interventional cycles, intensity of mastalgia was measured using visual analogue scale. Analysis of covariance showed a significant difference among the three groups regarding the mean intensity of cyclical mastalgia in the first and second cycles of the interventions (P < 0.001). Also, repeated measures analysis of covariance with adjustment of two variables of age and mastalgia intensity of the baseline cycle demonstrated that flaxseed bread was more effective compared to omega-3 and wheat bread (P < 0.001). The results of this study demonstrated that flaxseed bread diet was an effective approach in decreasing cyclical mastalgia and could be prescribed to women as a simple treatment with few complications.