Study 1: Nayeri et al.(12)
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53 subjects used lanolin ointment (20g tubes) 1g, 3 times/day in areola and nipple + observation of breastfeeding and guidance on the correct latch on. The women evaluated were between 3 and 7 days postpartum |
53 subjects used chamomile ointment 1.5%, 1g, 3 times/day in areola and nipple + observation of breastfeeding and guidance on correct latch on. The women assessed were between 3 and 7 days postpartum |
3 and 7 days |
Pain assessment by the Visual Analogue Scale showed significantly less pain in the intervention group on the 3rd (p<0.001) and 7th day (p<0.001). Symptom assessment by the Storr scale showed significantly less severity in the intervention group on the 3rd (p<0.001) and 7th day (p=0.041) |
Chamomile was more effective in reducing pain and symptoms |
Study 3: Mariani Neto et al.(14)
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90 women used breast milk at the end of each feeding, applying a thin layer of breast milk to the site of pain and nipple trauma, waiting to dry naturally +guidelines on the positioning of the baby and proper latching on to the nipple-areola region + guidelines on washing the breasts and bra daily with water and neutral soap and not using additional care. Women were still included in the maternity ward, but the exact period of recruitment of participants after childbirth was not specified |
90 women used highly purified lanolin (Lansinoh Laboratories, Inc) applying a thin layer to the painful and traumatized nipple area, waiting to dry naturally + guidelines on positioning the baby and proper latching on to the nipple-areola region during breastfeeding + guidelines on washing the breasts and bra daily with water and neutral soap and not using additional care. Women were still included in the maternity ward, but the exact period of recruitment of participants after childbirth was not specified |
2 and 7 days |
Pain assessment by the numeric and verbal pain assessment scale showed significantly less pain in the intervention group (p<0.001). Nipple trauma assessment by the Nipple Trauma Score showed significantly less severity in the intervention group on the 2nd day (p=0.667) and 7th day (p=0.025) |
Lanolin was more effective in reducing pain and improving the score of nipple-areolar injuries |
Study 4: Coca et al.(15)
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26 women received guidance on positioning and correct latch on + guidance on the use of breast milk before and after breastfeeding at the site of injury. Women were recruited while still in the maternity ward, but the exact postpartum period was not specified. |
24 women made topical use of anhydrous lanolin ointment by applying a thin layer on the nipple region and the injury, awaiting natural drying + guidance on positioning and correct latch on. Women were recruited still in the maternity ward, but the exact postpartum period was not specified |
24 hours |
Nipple-areolar injury assessment was performed by measuring the injury size, which showed a significantly greater decrease in the injury in the intervention group (p<0.001) |
Lanolin was more effective in decreasing the size of nipple-areolar injuries |
Study 5: Abou-Dakn et al.(16)
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39 women used breast milk, expressing and massaging the breast, applying drops of milk after each feeding, letting it dry naturally + guidelines on hand hygiene with soap and water before breastfeeding, correct breastfeeding practices and not using additional care. The postpartum period was not specified |
45 women covered the areola with approximately 0.25g of highly purified lanolin on the nipple and areola, allowing it to dry naturally + guidelines on hand hygiene before breastfeeding, correct breastfeeding practices and not using additional care. The postpartum period was not specified |
3, 7 and 14 days |
Pain assessment by the Visual Analogue Scale showed significantly less pain in the intervention group on the 3rd (p=0.00), 7th (p=0.03) and 14th days (p=0.04). Nipple-areolar injury assessment by photographs and classification by Nipple Trauma Score showed significantly less severity in the intervention group on the 3rd (p=0.00) and 7th days (p=0.00). On the 14th day, there was no difference (p=0.16) |
Lanolin was more effective in reducing pain and accelerating tissue repair of nipple-areolar injuries after 3 and 7 days of intervention |
Study 6: Coca et al.(17)
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29 women received 3 sessions of laser light irradiation in the powerless red spectrum (placebo) + guidance on proper position, correct latch on and breast care. Women were assessed during the first hours postpartum until hospital discharge |
30 women received 3 sessions of low power laser therapy emitting continuous visible red light (660 nanometers) with an InGaAIP semiconductor and 40 milliwatts of power (action site size 4mm2), adjusted to an energy density of 5 Joules per cm2 in 5 seconds (0.2 Joules per site). There was emission in 3 points (0.6 Joules in total), in the center of the injury, the right and left extremities + guidance on proper position, correct latch on and breast care. Women were assessed during the first hours postpartum until hospital discharge |
0, 24 and 48 hours |
Pain assessment by the Visual Analogue Scale showed pain reduction in the intervention group, with statistical significance after the second intervention (p = 0.016). After the first (p = 0.050) and the third intervention (p = 0.392), the results were not statistically significant. There was no statistical difference between groups after the third intervention |
Photobiomodulation with low-power laser was more effective in the intragroup in reducing pain after 24 hours of intervention |
Study 7: Firouzabadi et al.(18)
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50 women used drops of breast milk 2 times/day after the end of breastfeeding 50 women coated the nipple with mountain honey, twice a day, after the end of breastfeeding 50 women washed their breasts with boiled millefeuille (30g + 1L water for 10 minutes) 2 times a day, after the end of breastfeeding All of them received advice on the correct breastfeeding technique. The postpartum period was not specified |
1, 3 and 7 days |
Symptom assessment by the Storr scale showed significantly less severity in the 3 groups over time (1, 3 and 7 days), with p<0.001 in each group. In the assessment between groups, there was no difference at any time |
There was no difference in efficacy between the 3 interventions for improvement of pain-related symptoms and cracked nipple(18)
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Study 8: Abdoli et al.(19)
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40 women used breast milk on the nipple and areola after breastfeeding at least 4 times a day and letting it dry naturally + teaching the correct method of breastfeeding and distributing educational pamphlets. The postpartum period was not specified |
40 women made topical use of a sachet of Achillea millefolium (millefeuille) tea, previously soaked in hot water, applied to the nipple and areola for 15 minutes, letting it dry naturally, at least 4 times a day + teaching the correct method of breastfeeding and distribution of educational pamphlets. The postpartum period was not specified |
4, 8 and 14 days |
Cracked nipple assessment by the Storr scale showed significantly less severity in the intervention group on the 4th (p<0.01), 8th (p<0.001) and 14th days (p<0.001). Pain assessment by the Visual Pain Scale showed significantly less pain in the intervention group on the 4th (p<0.001), 8th (p<0.001) and 14th days (p<0.001) |
Millefeuille was more effective in reducing pain and lessening injuries. |