Pleurisy is an inflammation of the pleura, a large, thin sheet of tissue that wraps around the outside of your lungs and lines the inside of your chest cavity. Between the layer of the pleura that wraps around your lungs and the layer that lines your chest cavity is a very thin space called
the pleural space. Normally this space is filled with a small amount of fluid that helps the two layers of the pleura glide smoothly past each other as your lungs breathe air in and out. Pleurisy occurs when the two layers of the pleura become red and inflamed, rubbing against each other every time your lungs expand to breathe in air. Infections like pneumonia are
the most common cause of pleurisy. The main symptom of pleurisy is a sharp or stabbing pain in your chest that gets worse when you breathe in deeply or cough or sneeze. The pain may stay in one place or it may spread to your shoulder or back. Sometimes it becomes a fairly constant dull ache. Depending on what's causing the pleurisy, you may have other symptoms, such as: Shortness of breath A cough Fever and chills Rapid,
shallow breathing Unexplained weight loss A sore throat followed by pain and swelling in your joints Your doctor will find out if you have pleurisy or another pleural disorder by taking a detailed medical history and doing a physical exam and several diagnostic tests, including: Chest X-ray to show air or fluid in the pleural space, and what's causing the condition (for example, pneumonia, a fractured rib, or a lung tumor) CT scan that
can show pockets of fluid, signs of pneumonia, a lung abscess or a tumor Ultrasound, which can show where fluid is located in your chest Magnetic resonance (MR) scan,
which can show pleural effusions and tumors Blood tests, which can show whether you have a bacterial or viral infection, pneumonia, rheumatic fever, a pulmonary embolism or lupus Arterial blood gas tests, which show how well your lungs are taking in oxygen A procedure called
thoracentesis is used to remove fluid from the pleural space. The doctor inserts a needle or a thin, hollow, plastic tube through the ribs in the back of your chest into your chest wall. A syringe is attached to draw fluid out of your chest. To relieve symptoms, your doctor may recommend: Acetaminophen or anti-inflammatory agents, such as ibuprofen, to control pain Codeine-based cough syrups to control a cough Lying on the painful side to make
you more comfortableWhat is pleurisy?
Symptoms
Diagnosis
Treatment
Breathing deeply and coughing to clear mucus as the pain eases
Your doctor will look at the fluid under a microscope to determine what's causing the fluid buildup. If the fluid is infected, treatment involves antibiotics and draining the fluid. If the infection is tuberculosis or from a fungus, treatment involves long-term use of antibiotics or antifungal medicines. If the fluid is caused by tumors of the pleura, it may build up again quickly after it's drained. Sometimes antitumor medicines will prevent further fluid buildup. If they don't, the doctor may seal the pleural space.
1. Why do my breasts hurt?
2. Breast pain linked to periods
3. Breast pain not linked to periods
4. Chest wall pain
5. Diagnosis
6. Treatment
7. Coping
1. Why do my breasts hurt?
Breast pain is very common in women of all ages.
Having painful, sore or tender breasts can cause a lot of anxiety. But on its own, pain in the breasts isn't usually a sign of breast cancer.
Many women experience breast pain as part of their normal menstrual cycle (periods). This is called cyclical breast pain.
Lasting pain in the breast that’s not related to periods is known as non-cyclical breast pain.
Sometimes pain that feels as though it's in the breast is coming from somewhere else, such as a pulled muscle in the chest. This is known as chest wall pain.
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2. Breast pain linked to periods (cyclical breast pain)
Many women feel discomfort and lumpiness in both breasts a week or so before their period.
The pain can vary from mild to severe and the breasts can also be tender and sore to touch.
You may experience heaviness, tenderness, a burning, prickling or stabbing pain, or a feeling of tightness.
The pain usually affects both breasts but it can affect just one breast. It can also spread to the armpit, down the arm and to the shoulder blade.
Cyclical breast pain is linked to changing hormone levels during the menstrual cycle. The pain often goes away once a period starts. In some women, this type of pain will go away by itself, but it can come back.
This type of pain usually stops after the menopause, though women taking hormone replacement therapy (HRT) can also have breast pain.
Breast pain can also be associated with starting to take or changing contraception that contains hormones.
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3. Breast pain not linked to periods (non-cyclical breast pain)
It’s often unclear what causes non-cyclical breast pain.
It can be related to:
- a benign (not cancer) breast condition
- previous surgery to the breast
- injury to the breast
- having larger breasts
- a side effect from a drug treatment, such as certain antidepressant drugs and some herbal remedies such as ginseng
Stress and anxiety can also be linked to breast pain.
Non-cyclical breast pain may be continuous or it may come and go. It can affect women before and after the menopause.
The pain can be in one or both breasts and can affect the whole breast or a specific area. It may be a burning, prickling or stabbing pain, or a feeling of tightness.
Non-cyclical breast pain often goes away by itself over time. This happens in about half the women who experience it.
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4. Chest wall pain
Chest wall pain may feel as though it’s coming from the breast, but really it comes from somewhere else.
It can have a number of causes, such as pulling a muscle in your chest.
Find out more about chest wall pain.
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5. Diagnosing breast pain
Your GP will examine your breasts and take a history of the type of pain you have and how often it occurs.
To check how long the pain lasts, how severe the pain is or if the pain is linked to your periods, your GP may ask you to fill in a simple pain chart.
If your GP thinks you may have non-cyclical breast pain or chest wall pain, they may ask you to lean forward during the examination. This is to help them assess if the pain is inside your breast or in the chest wall.
Your GP may refer you to a breast clinic where you’ll be seen by specialist doctors or nurses for a more detailed assessment.
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6. Treating breast pain
The options for treating cyclical and non-cyclical pain are often the same, though non-cyclical pain isn’t always as easy to treat.
If you have cyclical breast pain, your GP may reassure you that it’s a normal part of your monthly cycle.
Diet and lifestyle changes
Diet
Your GP may suggest some things you can try which might help reduce pain, but there’s limited evidence to show these work. These include:
- eating a low-fat diet
- increasing the amount of fibre you eat
- reducing caffeine and alcohol
Well-fitting bra
Wearing a supportive and well-fitting bra during the day, during any physical activity and at night can be helpful.
Relaxation and complementary therapies
Some women have found relaxation therapy useful in reducing their symptoms of cyclical breast pain, such as relaxation CDs or apps, or other complementary therapies such as acupuncture and aromatherapy.
Contraception
If your pain started when you began taking a contraceptive pill, changing to a different pill may help. If the pain continues, you may want to try a non-hormone method of contraception such as condoms, a non-hormonal coil (also called copper coil or IUD) or a cap (diaphragm).
HRT
If your pain started or increased while taking HRT and doesn’t settle after a short time, tell your GP.
Evening primrose or starflower oil
There’s evidence that having low levels of an essential fatty acid called GLA can contribute to cyclical breast pain. However, research has shown that taking additional GLA doesn’t always help the pain. Despite this, your GP may suggest that you try evening primrose or starflower oil (which contain GLA), as some women have found it helps them to feel better generally. Your GP will tell you how much to take and for how long.
Evening primrose oil doesn’t usually cause side effects, but a few people may feel sick, have an upset stomach or get headaches. It’s best not to take it if you’re pregnant or trying to get pregnant. People with epilepsy are usually advised not to take evening primrose or starflower oil.
Pain relief
Research has shown that non-steroidal anti-inflammatory pain relief, such as ibuprofen, can help breast pain, particularly non-cyclical pain.
This type of pain relief can be applied directly to the affected area as a gel. It can also be taken as a tablet.
Before using this type of pain relief you should be assessed and get advice from your doctor on the correct dose, how long you should use it for and any possible side effects, especially if you have asthma, stomach ulcers or any problem related to your kidneys.
Paracetamol can also be useful in relieving breast pain, either with or without anti-inflammatory pain relief.
Hormone drugs
If your pain is severe, prolonged and hasn’t improved with any of the options already mentioned, your doctor may want to consider giving you a hormone-suppressing drug.
The drugs that are most commonly used to treat breast pain are:
- danazol
- tamoxifen: not licensed to treat breast pain and commonly used to treat breast cancer, but research has shown it’s also effective in treating cyclical breast pain so it’s sometimes used for this
These drugs have side effects, so will only be recommended after a discussion about the benefits and possible risks.
If you’re prescribed one of these drugs, your specialist will tell you what dose to take and for how long.
There’s some evidence that younger women may benefit from a short course of treatment, which can be repeated as necessary, whereas older women who are near to or going through the menopause may benefit from a longer course of treatment.
Treating chest wall pain
Find out more about treatment for chest wall pain.
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7. Coping with breast pain
Breast pain can be very distressing, and many women worry that they may have breast cancer. In most cases breast pain will be the result of normal changes in the breasts.
Even though you may feel reassured that your breast pain is normal and you don’t have breast cancer, the pain often remains. This can be upsetting, especially if your specialist can’t tell you the exact cause of your breast pain.
Women affected by breast pain may feel many different emotions, including fear, frustration or helplessness. Although understanding more about your breast pain won’t cure it, it may help you to get back some control over your life.
Having severe, long-lasting breast pain can sometimes affect a woman’s daily activities which may cause anxiety and, for some, depression. However, this isn’t the case for most women and their pain can be helped or managed.
Having breast pain doesn’t increase your risk of breast cancer. However, it’s still important to be breast aware and go back to your GP if the pain increases or changes, or you notice any other changes in your breasts.