Nipple pain is a widespread issue that affects many breastfeeding mothers, particularly in the early postpartum period. It is often caused by mechanical trauma due to improper latch, poor infant positioning, or repeated friction during feeding. Visible signs of nipple damage include cracks, fissures, redness, and swelling. If left untreated, these issues can cause significant pain, infections, and may lead to early cessation of breastfeeding.

A variety of treatments have been explored to alleviate nipple pain, ranging from topical applications like lanolin, aloe vera, and olive oil to more advanced interventions like low-level laser therapy (LLLT) and hydrogel dressings. Understanding which treatments are supported by evidence can help lactation consultants provide effective support to mothers dealing with nipple pain.

Evidence for Specific Treatment Options

Lanolin Ointment

• Evidence: Lanolin has been widely used for its ability to create a protective barrier, which helps retain moisture and reduce dryness on the skin. Research indicates that while lanolin may offer moderate relief for nipple pain, its effectiveness is not significantly better than that of breast milk application. One study found that both lanolin and breast milk reduced pain, but there was no substantial difference between the two treatments​ (Peric et al., 2023).
• Use: Lanolin is often recommended due to its availability and ease of use, with some mothers reporting subjective satisfaction despite mixed evidence of its effectiveness​ (Neto et al., 2018;  NIPPLE PAIN).

Aloe Vera Gel

• Evidence: Aloe vera has demonstrated anti-inflammatory and wound-healing properties, making it a promising option for reducing nipple pain and promoting healing. Studies have shown that aloe vera gel is more effective than lanolin in reducing pain scores and accelerating the healing of nipple trauma​ (Wang et al., 2024  ; Gao et al., 2021).  In one clinical trial, mothers using aloe vera experienced significant pain relief within the first few days of use​ (Asadi et al., 2017).
• Use: Aloe vera gel can be applied after breastfeeding to soothe irritation and facilitate tissue repair, making it a valuable option for managing nipple pain​ (Wang et al., 2024).

Breast Milk Application

• Evidence: Breast milk has natural antibacterial properties and is traditionally used to treat nipple pain. However, research comparing its efficacy to other treatments, like lanolin and hydrogel dressings, shows inconsistent results. Some studies found no significant advantage of using breast milk over other topical treatments​ (Vieira et al., 2017; Peric et al., 2023).
• Use: Applying expressed breast milk to the nipples and allowing it to air dry is a common practice, but it may not be as effective as other more specialized treatments​ (Vieira et al., 2017).

Low-Level Laser Therapy (LLLT)

• Evidence: LLLT uses specific wavelengths of light to reduce inflammation, relieve pain, and promote tissue healing. Studies indicate that LLLT provides significant pain reduction compared to placebo treatments, particularly in cases of severe nipple trauma​ (Coca et al.,2016; Nozimoto et al., 2024). Mothers treated with LLLT reported a quicker reduction in pain and faster healing times.
• Use: This therapy is typically administered by healthcare professionals and may not be widely accessible, but it offers a non-invasive solution for persistent nipple pain​ (Coca et al.,2016).

Hydrogel Dressings

• Evidence: Hydrogel dressings maintain a moist healing environment, providing immediate pain relief and promoting faster healing of nipple fissures. Research has shown that hydrogel pads are effective in reducing pain and are superior to lanolin in terms of comfort and healing speed​ (Gao et al., 2021; Nakamura et al. 2024).
• Use: These dressings can be placed over the nipples between feedings, providing ongoing protection and soothing relief​ (Gao et al., 2021; Nakamura et al. 2024).

Consensus on Best Evidence-Based Treatments

Based on current research, a combination of proper breastfeeding education and topical treatments seems to offer the best outcomes for managing nipple pain. Aloe vera gel and hydrogel dressings have shown the most consistent evidence for reducing pain and promoting healing, making them strong recommendations for lactation consultants. In cases where severe pain persists, low-level laser therapy (LLLT) may be an effective option, although its accessibility may be limited​ (Gao et al., 2021; Coca et al., 2016).  

While traditional remedies like lanolin and breast milk are still commonly used, newer treatments such as aloe vera and hydrogel dressings are supported by stronger evidence for effectiveness​ (Vieira et al., 2017; Nakamura et al., 2024).  

Key Takeaways for Lactation Consultants

• Prioritize breastfeeding education: Ensuring that mothers are using proper latch and positioning techniques can prevent most cases of nipple pain (Neto et al.,2018; NIPPLE PAIN).
• Tailor treatments to individual needs: Assess the severity of nipple trauma and consider both traditional and newer treatment options, such as aloe vera gel or hydrogel dressings​ (Wang et al., 2024; Gao et al., 2021).
• Encourage evidence-based practices: While lanolin and breast milk are popular, emerging evidence suggests that aloe vera and hydrogel dressings may provide better pain relief (Asadi et al.,2017; Nakamura et al., 2024).
• Support early intervention: Addressing nipple pain as soon as it arises can prevent complications, promote healing, and improve breastfeeding success (Gao et al., 2021; Coca et al., 2016).

References

Coca, K. P., Marcacine, K. O., Gamba, M. A., Corrêa, L., Aranha, A. C. C., & Abrão, A. C. F. V. (2016). Efficacy of low-level laser therapy in relieving nipple pain in breastfeeding women: A triple-blind, randomized, controlled trial. Journal of Human Lactation, 32(3), 538-546.

Perić, O., Bošnjak, A. P., Mabić, M., & Tomić, V. (2022). Comparison of lanolin and human milk treatment of painful and damaged nipples: A randomized controlled trial. International Breastfeeding Journal, 17, 35-45.

Vieira, F., Mota, D. D., Castral, T. C., Guimarães, J. V., Salge, A. K. M., & Bachion, M. M. (2017). Effects of anhydrous lanolin versus breast milk combined with a breast shell for the treatment of nipple trauma and pain during breastfeeding: A randomized clinical trial. Journal of Midwifery & Women’s Health, 62(2), 196-202.

Wang, R.-H., Gong, J.-Y., Liu, P.-C., Liu, L.-F., Zhang, J.-T., Yao, L., & Jia, S.-H. (2024). Effects of aloe gel on lactating women with nipple trauma. Breastfeeding Medicine, 19(1), 15-23.

Can Gürkan, Ö., Abbasoğlu, D., Özkan, H. A., & Aliogullari, A. (2022). Cacao butter as prophylaxis for nipple problems: A pilot randomized controlled study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 276, 89-96.

Nozimoto, M., Nakajima, Y., & Fukuda, H. (2024). Nonpharmacological interventions for breastfeeding nipple pain: A systematic review. Scientific Reports, 14, 1-15.

Nakamura, M., Luo, Y., & Ebina, Y. (2024). Effectiveness of moisturizing therapy in treating nipple trauma: A systematic review protocol. BMJ Open, 14(9), e025526.

Barros, N. R., Santos, R. S., Miranda, M. C. R., Bolognesi, L. F. C., & Borges, F. A. (2019). Natural latex-glycerol dressing to reduce nipple pain and heal the skin in breastfeeding women. Skin Research and Technology, 25(2), 123-130.

Alikamali, M., Emadi, S. F., Mahdizadeh, M., Emami, Z., Akbari, H., & Khodabandeh-Shahraki, S. (2023). Comparing the efficacy of breast milk and coconut oil on nipple fissure and breast pain intensity in primiparous mothers: A single-blind clinical trial. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 52(4), 462-470.

Savaş, E. H., Tümkaya, M. N., Semerci, R., & Eroğlu, K. (2024). Comparison of the effect of natural products and breast milk for preventing and treating nipple trauma and pain in lactating women: A systematic review and meta-analysis. Journal of Maternal-Fetal & Neonatal Medicine, 37(7), 1084-1092.