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

Abstract

Aims To describe and evaluate pain scales used to measure nipple pain in breastfeeding women and to identify nipple pain intensity in women with or without nipple damage. Background Nipple pain is one of the most common reasons given for premature cessation of breastfeeding. However, there are no agreed tools to measure pain and no previous reviews have provided summary estimates of pain scores. Design Systematic review. Data sources Medline, CINAHL, Scopus, Web of Science, SciELO, and LILACS. Review methods We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. The guiding question was: How is nipple pain in breastfeeding women measured and how severe is it? We analysed articles published up to February 2018, excluded review articles and those that did not present the level of nipple pain or tools to estimate pain severity. Results A total of 1,023 articles were identified and 25 were included in the review after applying the exclusion criteria. The Numeric Rating Scale (nine studies) and Visual Analogue Scale (seven studies) were the most prevalent tools for measuring pain. Using a pain score between 0–10, women with nipple damage reported a weighted mean of 6.2 in the first week and 5.8 after that period; women without damage reported a weighted mean of 2.7. Conclusion Women with nipple damage consistently reported a higher level of pain than women without damage. To prevent premature cessation of breastfeeding, it is important to help new mothers avoid nipple damage.

Identifying the cause of breast and nipple pain during lactation

“…Look for nipple damage34 and other signs that may suggest the cause of the pain (there may be none):…”

The effectiveness on health education to prevent nipple trauma from breastfeeding: a systematic review

“…28 Inadequate position and latch during feeding are the main causes of nipple trauma 13,33 and, consequently, causes persistent nipple pain, 34 usually of high intensity. 35 Thus, health education on breastfeeding, whether individual or in group, focuses on the proper breastfeeding technique that should be routinely provided in the prenatal and postpartum period from the first feeding, 36 with a follow-up of at least two visits. 37 Puerperal women who receive demonstrationbased training have higher positive scores for use of the correct feeding technique than the puerperal women of the other groups (p<0.05).…”

OXTR rs53576 variation with breast and nipple pain in breastfeeding women

“…Clinically, the evaluation of breastfeeding pain is almost exclusively dependent on self-report measures by breastfeeding mothers. The most common evaluation used in breastfeeding studies to effectively capture changes in breast and nipple pain across time is the visual analogue scale (VAS) (Coca et al, 2018; McClellan et al, 2012). While the VAS is a validated global measure of pain severity or intensity, the VAS may not capture modality-specific differences in somatosensory aberrations that may contribute to pain sensitivity (i.e.…”