Breast pain | Most up cycles

What exactly causes the programmed cycle in women from breast discomfort women, is still unclear. Of course, the sex hormone fluctuations and changes related to the role.

While in the first half cycle estrogen dominates, both progesterone progesterone in the body, also called progesterone. In the rhythm of the hormonal changes occur before menstruation among others, increased water retention (edema) in the breast. Edema is one of the causes of chest discomfort.

While many women experience a feeling of increased tension in fact, go with it but it is quite obvious. However, some have a real problem, as the month of breast pain is very unpleasant. Not only that, can swell eyelids, hands, feet, and legs but for a while. As a result, the balance appears while. Not only, but also why many women feel completely comfortable before menstruation.

There are also sometimes other symptoms, such as on a psychological level. The transition to the so-called premenstrual syndrome (PMS) is often blurred. For many women, the mood changed with an increase in irritability, nervousness or sluggishness "in the days before the days" until a certain point is normal. PMS but they will be felt and experienced as extremely detrimental.

Also, rising for the second phase of the cycle of the hormone prolactin from the pituitary gland affects breast tissue: Finally, it is to prepare the glandular cells in milk production. Thus, a better network supplied with blood, and gland cells begin to prepare for the possibility of pregnancy: putting growth and increase their production of secretion.

A special sensitivity of breast tissue to prolactin could potentially increase cyclic breast pain. Prolactin is incidentally also in men. Increased breast form with them (gynecomastia, see below) may be associated with prolactin.

Very often occurs in women of childbearing years, called fibrocystic breast disease develops (see chapter "-siklus dependent"). It is accompanied by often emphasized cyclical, marked tenderness of the breasts. Physician, the appropriate changes, for example, by imaging modalities such as ultrasound breast (breast sonography) is well recognized (see also section "Diagnostics"). Depending on the severity of the doctor advised sometimes for further analysis, because every feature fibrocystic breast disease can increase the risk of breast cancer slightly.

The Diagnosis of Persistent Somatoform Pain Disorder

According to the clinical diagnostic guidelines ICD-10 should be criticized in several ways:

1. Ignoring the organic substrate does not reflect the reality of the pain, even if they are primarily psychological or psychosocial reasons. With this diagnosis, the body-soul dualism Cartesian reflect that there is "real", that pain-related physical and imaginary, that is mentally induced pain. After the biopsychosocial model of disease different definitions would be more appropriate. The term "pain disorder" without "somatoform" when he was elected in the DSM-IV, not the fact that the "psychogenic" pain caused by organic substrates (may) have, although this is due to the current state of the science is often still not sufficiently known. The concept of persistent somatoform pain disorder according to the clinical diagnostic guidelines for ICD-10 exposed to the risk that should initially umdiagnostiziert as "somatoform" pain disorder is defined through the advancement of medical science, more and more, because of the organic substrate is detected, although at the same symptoms of mental and psychosocial factors involved as before.
2. Realization of psycho-physiological mechanisms, such as is the case with painful muscle tension (tension headaches), will lead to a different diagnosis of F45.4, which is the main code of non-psychiatric field, although psychosocial stressors known as triggers. This criticism is not mitigated by the fact that the ICD-10 pain described also not pure organic referred to as "somatoform".
3. In ICD-10, which is quite important differences between acute and chronic somatoform pain disappear. The suffix "persistent" ignores the difference between acute and chronic pain, such as that carried out in the DSM-IV. With the requirement for persistent pain pain disorders in ICD-10 is ignored so that last less than six months. In pain lasting psychological and social factors that are shorter also play an important role.

ICD-10 diagnosis of "persistent somatoform pain disorder" diagnosis is based on the same problematic "somatoform pain disorder" of the previous American Psychiatric diagnostic scheme DSM-III-R. This diagnosis is not suitable for many patients with chronic pain and does not apply to patients with acute pain, where both psychological and social factors in pain trigger or amplify.

DSM-III-R call for continued work with the pain for at least six months, while DSM-IV considers the pain itself as the main criteria for diagnosis. It was at that time not yet distinguish between acute and chronic pain.

Psychogenic Pain Disorder

Pain is the signs and symptoms of a disease. If the pain itself becomes a problem, has been discussed for DSM-III, namely (Called at that time "psychogenic pain disorder") since 1980, from pain disorders.

Persistent somatoform pain disorder (F45.4) is characterized by the clinical diagnostic guidelines for ICD-10 with the following features:

Dominant complaint is persistent pain, severe and excruciating.

The pain is caused by a physiological process or a physical disorder is not fully understood.

The pain occurs in association with emotional conflict or psychosocial problems.

Conflicts and problems should be so severe that they can be regarded as a decisive causal influence.

The pain usually has the care or medical attention or personal results are significant.

According to the ICD-10 research criteria are somatoform pain disorder lasts defined by the following two features [27]:

A. There are at least six months, constantly, constantly in almost every day, heavy and burdensome pain in the body that can not be adequately described by a physiological process or a physical disorder, and attention is directed eternal gravity concerned.

B. The disturbance does not occur exclusively during the period or certain other diseases (schizophrenia or related disorders, affective disorders, somatization disorder, undifferentiated somatization disorder, hypochondriacal disorders).

As the term "related" (synonym) applies in the following designations ICD-10: psychalgia, back psychogenic or somatoform pain disorder headache. Pain due to known or suspected psychophysiological mechanisms, such as muscle tension, pain or migraine that "may psychogenic" according to ICD-10, not part of somatoform pain disorder, but the F54 code ("psychological factors and behavioral factors in other diseases classified elsewhere ") and by using an additional code from other areas of the ICD-10 (eg, migraine G43) to classify.

Tension headache (G44.2), back pain unspecified (M54.9) and unspecified acute or chronic pain (R52) which, according to the ICD-10 guidelines somatoform pain disorder is not constant. Presumably, psychogenic pain during depression or schizophrenia should not be included in the diagnosis as well. The most common pain that psychological factors play a role, which is a lot of headaches and backaches are not considered somatoform pain disorder, but as the pain in which psychological factors and behavioral factors play a role (F54).

Psychophysiological mechanisms such as the functional muscle tension (eg headaches due to muscle contraction) may therefore on somatoform pain disorder is not available, since this is the event of nociceptive pain, even if the tension was initially triggered by psychosocial stress factors.

Criteria of time (at least six months duration) and a continued focus on patient care is required on pain symptoms - in the ICD-10 research criteria - unlike in the clinical diagnostic guidelines. It was decided to criteria serious emotional conflict or psychosocial problems as "determining the causal influence" on the pain, it will throw exclusion criteria for certain mental disorders. Thus, sustained pain other somatoform pain disorder can be calculated if the "inadequate" (according to the guidelines of "complete") can be explained by organic factors.

Published only after the clinical diagnostic criteria of ICD-10 research guidelines - such as the DSM-IV - throw with emotional and conflict assessment of psychosocial factors as important causal influence. The pain may simply can not be explained purely organic. Examiner does not have to leave the problematic assessment, therefore, whether the degree of pain exceeds the expected also in accordance with the degree of physiological findings.

Persistent Somatoform Pain Disorder 2 in Case | Breast Pain Blog

Somatoform Disorder

A technical executive with 52 years of making an application for disability retirement because of chronic pain. Freiburger list and the short version of Giessen Complaint arc he reached a high degree of severity of pain in almost all areas covered. Various specialists can find the cause of his discomfort organic require somatoform pain disorder is assumed. He is always sick, why he has so often in the past two years on sick leave, he immediately had to take into account termination and subsequent unemployment if he can not get a pension. He suffered for at least three years, primarily from back pain, neck pain, joint pain and abdominal pain. In addition to pain killers antidepressants him from her neurologist. He was really depressed for a long time because he wished that he had would belong to the next worker because of his age who wants to reduce his company. Although he had previously been very tense, which he visited masseuse confirmed, but for several years it was very bad. Of history proved that the wife had been diagnosed with breast cancer four years ago and had relapsed six months ago. These can be symptoms of somatoform pain also strengthened as demotivation in the workplace, where he had lost a previous job with the company's restructuring. A decline in cognitive performance and Mnemic where patients have complained to the neurological examination done before, is the psychological examination is not visible, but sensorimotor retardation and poor sustained attention capacity.

A woman 35 years complained for three years on chronic pelvic pain. You have visited a total of five gynecologists in the course of time, but no one could help her. They continue to draw a pain in the abdomen and lower waist without organic cause, which has once again, sometimes less obvious. In addition, they suffer in varying degrees from headaches, back pain, circulatory problems, loss of libido and pain during sexual intercourse. A female doctor who persuaded him to psychotherapy, although he could not imagine what it would be changed by it. It turns out her husband for several years now have alcohol addiction treatment without insight. He wanted to sleep more often drunk with it. He could not escape him, because when they have tried this once, he had beaten her. They endure all just because kids. You can also financial reasons, but also separate.