Quantitative Sensory Testing, Antihistamines, and Beta-Blockers for Management of Persistent Breast Pain: A Case Series

Muddana, Anitha; Asbill, Diane T.; Jerath, Maya R.; Stuebe, Alison M.

doi:10.1089/bfm.2017.0158

Cited by 7 publications

(10 citation statements)

References 38 publications

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“…Muddana et al (2014) recently described cases of persistent breast and nipple pain without resolution using an attenuated QST assessment to identify differences in somatosensory functioning. The findings suggested a potential role for pain sensitization in the development of breast and nipple pain as has been identified in various other experimental and clinical pain outcomes (Diatchenko et al, 2005; Fillingim et al, 2005; Muddana, Asbill, Jerath, & Stuebe, 2018). While the emergence of painful conditions may be affected by development and environmental experiences, genetic factors contribute to individual differences in pain susceptibility across the lifespan.…”

Section: Introductionmentioning

confidence: 57%

“…QST has been used in chronic pelvic and low back pain conditions experienced in women (As-Sanie et al, 2013; Starkweather et al, 2016). In lactation, only one study attempted to use mechanical sensitivity testing using a toothpick on the breast (Muddana et al, 2018). However, no study has used a standardized mechanical QST protocol in women initiating breastfeeding to comprehensively evaluate breastfeeding pain.…”

Section: Introductionmentioning

confidence: 99%

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OXTR rs53576 variation with breast and nipple pain in breastfeeding women

Lucas

Zhang

Walsh

et al. 2020

Preprint

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Purpose: To evaluate associations among breast and nipple pain sensitivity and candidate pain sensitivity single-nucleotide polymorphisms [SNPs], (COMT rs6269, rs4633, rs4818, rs4680 and OXTR rs2254298, rs53576) in breastfeeding women. Design: A secondary analysis of sixty women participating in a pilot randomized controlled trial of a pain self-management intervention. Methods: All participants underwent standardized mechanical somatosensory testing for an assessment of pain sensitivity and provided baseline buccal swabs for genetic analysis. At 1, 2, and 6 weeks postpartum, women self-reported breast and nipple pain severity using a visual analogue scale. Results:- Women with the minor allele OXTR rs53576 reported 8.18-fold higher breast and nipple pain severity over time. For every 1-unit increase in mechanical detection threshold and windup ratio, women reported 16.51-fold and 4.82-fold higher breast and nipple pain severity respectively. Six women with the OXTR rs2254298 minor allele reported allodynia. Discussion: The presence of OXTR alleles in women with enhanced pain sensitivity suggests a phenotype of genetic risk for ongoing breast and nipple with potential for pain-associated breastfeeding cessation. Somatosensory testing identified women who reported higher breast and nipple pain during the first weeks of breastfeeding. Clinical Implications: Pain sensitivity testing can help to identify women at risk of intolerable and/or ongoing breastfeeding pain who may benefit from additional support to mitigate early breastfeeding cessation. Targeted interventions are needed to address breastfeeding pain, including management of infant latch, positioning, and infection as well as support for self-management of breastfeeding pain.

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Section: Introductionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

OXTR rs53576 variation with breast and nipple pain in breastfeeding women

Lucas

Zhang

Walsh

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Na categoria "Tratamentos não eficazes na redução da dor mamilar", foram incluídos cinco artigos que representam (45%) dos estudos dessa revisão. A categoria trata das terapêuticas não eficientes para o tratamento da dor mamilar (JACKSON; DENNIS, PUAPORNPONG et al, 2017;MUDDANA et al, 2018;AVIGNON, 2018;CAMARGO et al, 2020).…”

Section: Resultsunclassified

Trabalho Interprofissional Em Meio Ao Covid 19: Uma Reflexão Teórica

Melo¹,

Gouvêa²,

Ruiz³

et al. 2021

Saberes, Estratégias E Ideologias De Enfermagem 2

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“…Clinical protocols for persistent lactation-related nipple pain list allodynia and hyperalgesia as differential diagnoses, requiring referral for psychological or pain clinic support, or medications, such as propranolol or selective serotonin reuptake inhibitors. 76 , 84 , 85 …”

Section: Classification: Signs and Symptoms Of Excessively High Stret...mentioning

confidence: 99%

“…Similarly, a woman with hyperalgesia may experience slight nipple compression during let down as excruciating. 85 …”

Section: Classification: Signs and Symptoms Of Excessively High Stret...mentioning

confidence: 99%

Re-thinking lactation-related nipple pain and damage

Douglas

2022

Womens Health (Lond Engl)

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Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple–areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple–areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.

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Quantitative Sensory Testing, Antihistamines, and Beta-Blockers for Management of Persistent Breast Pain: A Case Series

Cited by 7 publications

References 38 publications

OXTR rs53576 variation with breast and nipple pain in breastfeeding women

OXTR rs53576 variation with breast and nipple pain in breastfeeding women

Trabalho Interprofissional Em Meio Ao Covid 19: Uma Reflexão Teórica

Re-thinking lactation-related nipple pain and damage

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