Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial

Abstract

Nipple pain and damage are commonly experienced by breastfeeding women and are associated with negative breastfeeding outcomes. Health care providers often recommend the application of lanolin to treat painful/damaged nipples, yet no randomized controlled trial has evaluated the effectiveness of lanolin on nipple pain and breastfeeding outcomes. The purpose of this study was to evaluate the effect of lanolin on nipple pain among breastfeeding women with damaged nipples. A randomized, single-blind, controlled trial was conducted at a tertiary care hospital in Hamilton, Ontario, Canada. Breastfeeding women (N = 186) identified as having nipple pain/damage were randomized to apply lanolin (intervention group; n = 93) or to receive usual postpartum care (control group; n = 93). The primary outcome was nipple pain at 4 days post-randomization measured by the Numeric Rating Scale. Additional outcomes included nipple pain measured by the Short Form McGill Pain Questionnaire, breastfeeding duration/exclusivity, breastfeeding self-efficacy, and maternal satisfaction with lanolin treatment versus usual care. The results revealed no significant group differences in mean pain scores at 4 days post-randomization. Women in both groups experienced clinically relevant decreases in nipple pain by 7 days post-randomization. Significantly, more women in the lanolin group reported that they were satisfied with treatment compared with those receiving usual care. No significant group differences were found for other secondary outcomes. While more women were satisfied using lanolin, its application to sore/damaged nipples was ineffective for reducing nipple pain or improving breastfeeding outcomes.

Measurement tools and intensity of nipple pain among women with or without damaged nipples: A quantitative systematic review

“…() studies—moderate—as well Mohamed Essa and Ebrahim () and As'adi et al. ()—moderate to severe—were similar to that reported in studies using the NRS (Araújo et al., ; Brent et al., ; Buck et al., ; Chaves et al., ; Jackson & Dennis, ; Marrazzu et al., ; Vieira et al., ) and the VAS (Abou‐Dakn et al., ; Akbari et al., ; Coca et al., ; Dennis et al., ; Duffy et al., ; McClellan et al., ) (Table ).…”

“…The most commonly used instruments to measure pain were one‐dimensional tools: NRS (nine studies) (Araújo et al., ; Brent et al., ; Buck et al., ; Chaves et al., ; Indraccolo et al., ; Jackson & Dennis, ; Marrazzu et al., ; Pugh et al., ; Vieira et al., ) and VAS (seven studies) (Abou‐Dakn et al., ; Akbari et al., ; Buchko et al., ; Coca et al., ; Dennis et al., ; Duffy et al., ; McClellan et al., ). The other scales identified were the Verbal Categorical Rating Scale (As'adi et al., ; Centuori et al., ; Mohamed Essa & Ebrahim, ; Shimoda et al., ) used in four studies; and the 1–5 Verbal Descriptor Scale used in three studies (Blair et al., ; Cadwell et al., ; Dodd & Chalmers, ); MPQ in Full in one study and Short‐Form version in two studies (SF‐MPQ) (Dennis et al., ; Jackson & Dennis, ; McClellan et al., ), and the Nipple Tenderness Scale in two studies (Lavergne, ; Shanazi et al., ). This last scale was referred to as the Nipple Soreness Rating by the author in one study (Lavergne, ) (Table ).…”

“…Pain intensity in women with nipple damage was measured by the NRS in seven studies (Araújo et al., ; Brent et al., ; Chaves et al., ; Jackson & Dennis, ; Marrazzu et al., ; Vieira et al., ) and six by the VAS (Abou‐Dakn et al., ; Akbari et al., ; Coca et al., ; Dennis et al., ; Duffy et al., ; McClellan et al., ). Data collection occurred between the 1st and the 90th day postpartum, predominantly on the first few days (Abou‐Dakn et al., ; Buck et al., ; Coca et al., ; Dennis et al., ; Jackson & Dennis, ).…”

“…The three studies using the McGill scale reported mean of 15.8 and 20 points from 45 and 75 points Short and Full form, respectively, in the first week postpartum (Dennis et al., ; Jackson & Dennis, ; McClellan et al., ) and two studies using the Verbal Descriptor Scale reported a mean pain score of 3.4 where the range was from categories 1 to 5 and 3 is “moderate pain” around second week postpartum (Blair et al., ; Cadwell et al., ). The study using the Nipple Tenderness Scale found 3.1 points of nipple pain, where 3 = “nipple beginning to crack and/or involuntary gasp of pain when baby starts breastfeeding” (Shanazi et al., ).…”

“…Of these, 25 were relevant to the guiding question and were included in this review. Of the 25 articles, 20 were RCTs (Abou‐Dakn, Fluhr, Gensch, & Wockel, ; Akbari, Alamolhoda, Baghban, & Mirabi, ; Araújo, Nascimento, Camargos, Silva, & Faria, ; As'adi, Kariman, Mojab, & Pourhoseingholi, ; Brent, Rudy, Redd, Rudy, & Roth, ; Buchko et al., ; Cadwell, Turner‐Maffei, Blair, Brimdyr, & Maja McInerney, ; Centuori et al., ; Chaves, Araujo, Santos, Pinotti, & Oliveira, ; Coca et al., ; Dennis, Schottle, Hodnett, & McQueen, ; Dodd & Chalmers, ; Duffy, Percival, & Kershaw, ; Jackson & Dennis, ; Lavergne, ; Marrazzu et al., ; Mohamed Essa & Ebrahim, ; Pugh et al., ; Shanazi et al., ; Vieira et al., ), three were cross‐sectional studies (Blair, Cadwell, Turner‐Maffei, & Brimdyr, ; McClellan et al., ; Shimoda, Aragaki, Sousa, & Silva, ), and two were cohort studies (Buck et al., ; Indraccolo, Bracalente, Di Iorio, & Indraccolo, ).…”