In the Australian Family Physician this week lactation consultants from the Women’s Dr Lisa Amir and midwife Miranda Buck (pictured) write about breast and nipple pain associated with breastfeeding.
They presented at the Lactation Consultants of Australia and New Zealand conference in Brisbane. Dr Amir will also run a workshop in Washington in July to introduce a new model they have helped developed that is a simple tool to help capture the complexity of the influences and causes of pain.
“Pain is a complex human experience that has multiple determinants and influences. When pain is intense, unpleasant or persistent it can lead to distress,” Dr Amir said.
“Equally though, evidence shows that people who are distressed may be more likely to report pain. So we can see that pain is not simply a reflection of damage in the cells and tissues of the body, but part of a broader and complex body protection system.”
Dr Amir said from a social perspective, pain can be seen as an expression of perceived vulnerability and threat.
“The pain associated with breastfeeding is no less complex than other presentations of pain. Currently, there is an over-simplified understanding of this pain, so we have developed a new model which recognises the complexity of pain during breastfeeding,” she said.
“In some cases there are clear pathological mechanisms at play, but evaluation should be multidimensional. Women find the difficulties associated with breastfeeding emotionally distressing.”
Dr Amir said also there were many stressors associated with having a new baby, including the potential for sleep deprivation.
“Research in experimental pain shows that neurobiological mechanisms that explain how emotional distress and sleep deprivation make the systems that provoke pain more sensitive,” she said.
“It is important to address all determinants and influences on pain to give the woman the best chance of successfully continuing with breastfeeding.
“This includes assessing and treating any infection in nipple and breast tissue, identifying and adapting to mechanical factors that might be impacting (e.g. shape of baby’s mouth; breast pump method), as well as using strategies to reduce distress and improve sleep.
“Combining our clinical skills in pain and lactation management we have a developed a new model to assist clinicians in assessing and managing nipple and breast pain in breastfeeding women.”
Dr Amir and Miranda Buck wrote the paper with physiotherapist Lester Jones. Aust Fam Physician 2015; 44(3):187-92.