Chlorhexidine spray was superior to a distilled water spray in 1 small RCT, the only double-blind study identified. A polyethylene film dressing decreased nipple pain in a single trial, but most women found it uncomfortable to remove.
Hydrogel dressing associated with infection
The only topical agent found to have any detrimental effect was a glycerin-based hydrogel dressing that was associated with an increased incidence of breast infections.1 The TABLE summarizes results of trials of topical agents for the treatment or prevention of nipple pain.1,3,4
Breast shields were ineffective in 1 RCT.1 In another RCT performed in Sweden, women who received peripartum care in a birthing center had more nipple pain than women who delivered in a traditional hospital setting (NNT=16).5
TABLE
How topical agents compare for treating or preventing nipple pain
| Agent* | Positive results | Equivalent results | Negative results |
|---|---|---|---|
| Expressed mother’s milk (EMM) | Superior to lanolin3 | Equivalent to warm water compresses and keeping nipples dry and clean1 Equivalent to tea bag compress1 Equivalent to lanolin1 Equivalent to lanolin, warm water compress, and no treatment1 Equivalent to no treatment3 | Inferior to warm water compress1 |
| Lanolin | Superior to hydrogel dressing1 | Equivalent to Emm1 Equivalent to warm water compress, Emm, and no treatment1 Equivalent to tea bag compress and no treatment1 Equivalent to no treatment1 Equivalent to hydrogel dressing and no treatment4 | Inferior to hydrogel dressing1 Inferior to Emm and no treatment3 |
| Hydrogel dressing | Superior to lanolin1 | Equivalent to lanolin and no treatment4 | Inferior to lanolin, associated with an increased rate of breast infections1 |
| Tea bag compress | Superior to no treatment1 | Equivalent to Emm1 Equivalent to warm water compress1 Equivalent to lanolin and no treatment1 | Inferior to warm water compress1 |
| Warm water compress | Superior to tea bag compress and Emm1 Superior to no treatment1 | Equivalent to Emm and keeping nipples dry and clean1 Equivalent to tea bag compress1 Equivalent to lanolin, Emm, and no treatment1 | |
| Chlorhexidine spray | Superior to distilled water spray1 | ||
| Polyethylene film dressing | Superior to no treatment1 | ||
| *Comparison treatments may appear more than once, based on results of studies found in the systematic review | |||
Recommendations
The International Lactation Consultant Association states that nipple pain is often the result of ineffective positioning and latch.6 The group recommends anticipatory guidance to prevent nipple pain. Additionally, a thorough clinical assessment of the nipple is indicated to rule out other causes, such as bacterial or fungal infection.