Treatment of Macromastia-Related Upper Back Pain

Initial Conservative Management

• The American Society of Anesthesiologists recommends NSAIDs as first-line therapy for effective pain relief over 2-12 weeks 1, 2
• Acetaminophen can be used as an adjunct or alternative to NSAIDs if they are contraindicated, and extended-release oral opioids may be considered for refractory back pain over 1-9 weeks, though this is typically excessive for macromastia-related pain 2, 3
• Physical therapy and exercise programs can provide back pain relief for 2-18 months, with a focus on postural correction and core strengthening 1, 2, 3
• Cognitive behavioral therapy, biofeedback, and relaxation training can provide relief for 4 weeks to 2 years 1, 2, 3

Interventional Procedures

• The BMJ guidelines strongly recommend against interventional spine procedures (epidural injections, facet injections, radiofrequency ablation) for chronic axial spine pain, as these do not improve morbidity or quality of life 4, 5