Hello fellow Lactnetters,

I'm hoping to tap into your collective brains regarding treatment for nipple pain…

I have worked with several mothers who have experienced heightened nipple pain w/breastfeeding to the point that they are unable to breastfeed even when highly motivated to do so.  The pain is just too unbearable!  A common denominator is that the mothers reported a past history of nipple sensitivity that intensified after breast surgery (augmentation or reduction) years prior.    Generalized skin sensitivity and a history of eczema have also been present with a few mothers.  

What I have noticed is that this seems to be a "mother" issue.   After ruling out the typical infant causes (poor positioning, tongue tie, poor latch, anatomical issues) and in the absence of maternal "clues"( rashes; s/s yeast; nipple distortion post latch; nipple trauma; poor nipple elasticity; anatomical issues, engorgement….) I am at a loss and wonder if some mothers are just very sensitive and have something like "nipple fibromyalgia??"     Does anyone have any thoughts or ideas on how to help these mothers beyond the standard care practices (hydrogel pads, NSS soaks, lanolin;  nipple shield use;  pumping to give nipples "a break," etc…)?

One thought has come to my mind….  

Has anyone ever had any experience w/use of topical lidocaine cream (i.e. EMLA cream) for severe nipple pain?    I am hoping for insight before I discuss this idea any further with an MD.

Here is my thought:  apply the cream to INTACT nipples one hour before breastfeeding.  Remove cream and gently WASH the nipples before breastfeeding to prevent oral transmission to infant.  

In my experience the numbness lasts for several hours (I used it for my daughter before blood draws and it worked like a charm).   It might allow the mother to feed at the breast at least a time or two a day until her nipples hopefully de-sensitize over time (?).

Per Lactmed:
Lidocaine concentrations in milk during continuous IV infusion, epidural administration and in high doses as a local anesthetic are low and the lidocaine is poorly absorbed by the infant. Lidocaine is not expected to cause any adverse effects in breastfed infants. No special precautions are required.[1][2][3] Labor pain medication may delay the onset of lactation.

Any thoughts or suggestions are welcome!

Thank you!

Sincerely and with great appreciation for your collective wisdom,
Amy

Amy Wagner, BS, RN, CCES, IBCLC
Lactation consultant
Hershey PA



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