<<ATTACHMENT_OR_CONTENT_BLOCKING_Raynaud's Phenomenon of the Nipple- A
Treatable Cause of Painful Breastfeeding.url.TXT>>
And at www.breastfeedingonline.com Under Dr. Jack Newman's Handouts:
The first choice for treatment is:
* Vitamin B6. This has shown to work by trial and error, but it does
seem to work. There is no scientific evidence that it works, but it does
nevertheless. It is safe and will do no harm. The dose is 150-200 mg/day
once a day for four days, followed by 25 mg/day once a day. The mother
continues it until she is pain free for a few weeks. It can be restarted if
necessary. If the pain resolves with the larger dose but returns with the
smaller dose, you can go back to the higher dose. If you have been pain free
for a week or two, try going off the vitamin B6. If vitamin B6 does not work
within a few days, it probably won't. It is then useful to try:
* Nifedipine. This is a drug used for hypertension. One 30 mg tablet
of the slow release formulation once a day often takes away the pain of
Raynaud's phenomenon. After two weeks, stop the medication. If pain returns
(about 10% of mothers), start it again. After two weeks, stop the
medication. If pain returns (a very small number of mothers), start it
again. No mothers I am aware of took more than three, two week courses. Side
effects are uncommon, but headache may occur.
* Nitroglycerin paste. We no longer recommend it, as severe headache
associated with its use is fairly common. It also does not work more than
about 50% of the time.
Handout #3b. Treatments for Sore Nipples and Sore Breasts. January 2003
Written by Jack Newman, MD, FRCPC. © 2003
I had a client who had tried everything to get her pain under control.
First she had a baby that was latching very well, no misshape to the nipple
and yet lots of pain... of course baby had thrush and the pediatrician had
not told mom to get treatment as well. Unfortunately after she finished
being treated for yeast, the pain changed... and it was for me, the first
case of Raynauds of the Nipple that I had seen that I felt was blatantly
obvious. I gave mom a lot of literature on Raynauds and reviewed what
suggestions should be most helpful. She tried all of the suggestions for
relief. Nothing worked very well for her.This mom had started pumping for
most feedings especially by the end of the day because as the day wore on
she could not tolerate the discomfort as much. She still had pain after she
pumped but it was not as severe. She also was noticing a decrease in her
milk because she was not nursing him as often. She had started adding
formula to make up the difference. Each time I saw her (which was weekly or
more) we went over all of the treatment options. Finally the only thing left
was Nifedipine and she really wanted to try it. I armed her with info to
take to her doctor and then I spoke with her provider and they prescribed it
for her, a little reluctantly, but they did it. After 24 hours of the
Nifedipine, she was exclusively nursing her baby, bringing up her supply
with increased feedings. After a few days she was pain free. Her
personality completely changed! She was SO happy to be able to nurse pain
free! Her baby was also much improved, no longer screaming after feedings.
She moved from our area just 3 weeks later and wrote the most beautiful note
of thanks...
Pam Price IBCLC, CBE
Lactation Services Coordinator
Women's Health
Trident Health System
9330 Medical Plaza Drive
Charleston, S.C. 29406
(843) 824-5013 office
(843) 728-9640 pager
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