Hello Everyone,
I have enjoyed the discussion of hot vs cold therapy for engorgement. It is
one of the many recommendations that we make in our practice which has very
little supportive research data. Indeed, research surveys of health
professionals reveals that counseling is generally not based on sound data
but on personal experience. Although this may be beneficial at times and
may be ok for over the fence discussions, it should not be the basis of our
interventions. We need to question hot vs cold and many other
recommendations. Early in my career I questioned limiting time in early
days of nursing---although it made logical sense to some, it did not to me.
And I was shocked that I could not find its origin anywhere in the
literature. Now we know from research studies based upon research studies
that it is not true  and that limiting time just seems to delay soreness
not prevent it. Regarding "hot vs cold" for engorgement, I think we do not
yet have a lot to base our judgments.
PHYSIOLOGY: I don't have a reference for this, but if I remember back in my
nursing skills 101 days(and that is a loooooong time ago!) and from Basic
First Aide: Ice the first 24 hours to reduce swelling and moist heat after
24 hours to increase circulation and thereby helping eliminate residual
fluid and cells in the area. Does this mean we can use both depending upon
the time and situation?
PREVENTION:     Does early and frequent nursing prevent it? Moon(1989) found
that frequent and early nursing did not prevent engorgement, it just
occurred earlier. Longer nursing, however,  was associated with less
engorgement. Storr (1987) found that prenatal breast massage was related to
less engorgement. Prevention is an area for further study and research. Is
there a method for prenatal conditioning to prevent nipple soreness and
engorgement????
COLD AND CABBAGE: Clinical reports tell us that women get relief from cold
cabbage leaves. Research studies:
        1. Nikodem, et al. 1993-Women in two groups-cabbage and routine
care(breast exercises). Cabbage group reported less engorgement(not
statistically significant) and more were bf at 6 weeks.
        2. Roberts, et al. 1995-Comparing room temperature cabbage leaves and cold
cabbage leaves, both were helpful, no difference.
        3. Robers, et al. 1995-Comparing iced gel packs and cold cabbage, both
significantly reduced pain.
        4. Roberts, et al. 1998-Comparing cabbaghe leaf extract and a placebo
cream-both were effective in relieving discomfort.
Is it the specific application that relieves engorgement or is the fact
that the mother is doing something that is helpful???
HEAT-No studies that I know of that have examined this treatment!
FURTHER STUDY IS NEEDED AND QUESTIONS THAT NEED ANSWERED!
        A comparison of hot and cold and no treatment.
        Comparisons that look at relief of discomfort as well as breatfeeding
outcomes at 6 weeks, etc.
        Applications at various times during the engorgement period.
And I am sure you all have many other questions!
Right now I think we all must take what available data we have, after
assessing each individual mother's situation, and making the best judgment
as to the appropriate treatment.