Breastfeeding Self-Management for Nipple and Breast Pain
Condition: Breastfeeding; Breast Pain
MeSH terms: Mastodynia
Study type: Interventional

Summary: 
      This pilot project will provide an understanding of the contextual variables responsible for
      breast and nipple pain during breastfeeding initiation. These variables include, genetic
      variation, pain sensitivity, reactivity, pain catastrophizing and perceived stress. The
      purpose is to understand the efficacy of self-management (SM) strategies on each of these
      contextual variables, in an effort to inform a personalized approach to managing
      breastfeeding pain and its effect on improved health outcomes.
    

Detailed description: 
      Breastfeeding (BF) is one of the most important early determinants of infant health and
      development. Duration of BF is significantly related to reduced incidence of infantile
      respiratory and gastrointestinal tract infections, obesity and asthma. However, over 35% of
      mothers cease exclusive BF during the first 6 weeks due to nipple and breast pain. While 90%
      of mothers report acute nipple and breast pain during the first week of BF initiation,
      approximately 30% will experience persistent pain (>10 days). Due to the significant impact
      of nipple and breast pain on BF duration, pain is a significant barrier for achieving public
      health outcomes.

      The following pilot project will test the feasibility of a Breastfeeding Self-Management
      (BSM) Intervention on BF outcomes in mothers with nipple and breast pain. In addition, the
      proposed study will provide a preliminary examination of genetic, psychological and
      somatosensory factors that predict nipple and breast pain and possibly, early cessation of
      BF.

      Individual factors, including genetic polymorphisms of pain sensitivity genes and the
      individual's interpretation of pain can influence pain facilitation or inhibition at the
      molecular level of pain processing. Moreover, maternal anticipation of pain may increase pain
      catastrophizing, perceived stress and reactivity contributing to increased peripheral and
      central sensitivity. Identifying strategies to increase mothers' BF knowledge, pain
      self-efficacy and self-regulation skills could lead to increased SM behaviors. Therefore,
      this pilot study was designed to target pain SM process factors (self-monitoring, knowledge
      of breast care, BF self-efficacy, pain self-efficacy, and problem solving) relevant to
      mothers who experience pain during BF. The overarching goal of this program of research is to
      improve nipple and breast pain SM in BF mothers and enhance their BF self-efficacy to achieve
      their BF goals.

      The proposed study will address a major barrier of BF duration by identifying factors that
      contribute to nipple and breast pain. The proposed SM intervention will specifically target
      pain information, pain self-efficacy and problem-solving as central components of the SM
      process. In addition, the investigators will examine the influence of peripheral and central
      sensitivity and frequency of catechol-O-methyltransferase (COMT) single-nucleotide
      polymorphisms (SNPs), on SM process and outcome variables over time to gain knowledge about
      the precise influence of the molecular context of pain on risk of nipple and breast pain and
      BF outcomes.
    

Intervention name(s): Self-monitoring of BF and intervention
Intervention type(s): Behavioral
Intervention description(s): Self-Monitoring: At discharge, mothers will complete daily diaries for self-monitoring to stimulate cognitive reframing on the occurrence, duration, and characteristics of nipple and breast pain, infants' latch and sucking pattern, positioning, length of each BF session, and the MAIBB.
Self-Regulation: To support self-regulation skills, mothers will be provided with several 5-minute video modules on pain and BF pain SM with additional resources links. After discharge mother will receive text message from a nurse 2X/week for BF support. Mothers may text the nurse for emergent BF support.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Breast and Nipple Pain; Quantitative Sensory Testing; Genotyping; Breastfeeding