NDC step-by-step guide to treating lactation-related nipple pain with light therapy in the clinic

What laser device is best to use?

This photo of the Handy Pulse laser device shows

• (A) Posterior view with operating switches

• (B) Lateral view

• (C) Anterior view showing light emission window with diffuser in situ

• (D) Same view as in (C) but diffuser has been removed and shows the laser and light emitting diodes.

This device has been selected as it is portable, lightweight, battery-operated/rechargeable, a Class 1 device therefore safe for use in the community, and affordable. It uses low fluence settings. The added benefit is that the combination of wavelengths represented in the device is most suited for treating conditions presenting with pain, inflammation and tissue breakdown.

Light therapy parameters using the Handy Pulse Laser are: pulsed 50Hz, 13.5mW, 905nm laser (and 635nm and 875nm LED wavelengths), 4J/cm2, 0.7cm2 spot size, pulse width 100ns, pulse energy 2.5µJ.

This device sells for about $700 Australian dollars, here.

Preparing your patient

1. Ensure that the pre-consultation questionnaire has been filled out, and your consultation reviewing her nipple pain and offering ongoing key management strategies is concluded.

2. Nipple pain whilst breastfeeding will be evaluated using a numeric pain rating scale (NPRS) from 0 (no pain) to 10 (worst pain imaginable) before the treatment program commences, and then before each subsequent treatment (that is, whilst waiting in the clinic reception area at the next appointment). The NPRS is a proven reliable tool for the assessment of acute pain and is a commonly used measurement tool for evaluating nipple pain in breastfeeding women32,33.

3. Ensure that the consent form is signed.

4. Position your patient comfortably on the examination couch in a supine position and ask her to expose the breast with nipple pain for treatment.

5. Provide her with her own light-occluding mask for use at each treatment, or place a folded face washer over her eyes to block out light.

6. Have patient wipe her breasts with a warm wet cloth if she has used applications or lotions on her nipples and breasts.

Treating with the Handy Pulse device

1. NDC Accredited Practitioner (NDCP) puts on gloves for infection control.

2. Prior to every treatment session, the diffuser (shown in panel (C) of the photo of the Handy Pulse device at the top of this page) is covered with one layer of Tegaderm for hygiene purposes.

3. NDCP seats herself next to participant so that elbow is resting on examination couch and forearm can be braced with as little movement as possible for 5 minutes of treatment.

4. NDCP puts safety glasses on. These glasses come with the device.

5. Check that the device is set to “Variable”.

6. Place device with Tegaderm cover directly over and centred on the face of the affected nipple as close as possible with light physical contact (but no pressure). Please see the diagram above.

7. Press “ON”

8. One treatment of 5 minutes is administered to the nipple. Both nipples are treated if both nipples have persistent pain, which will be a total of 10 minutes.

9. During treatment check

   • How participant is feeling (if any feelings of discomfort at treatment site e.g., tingling, warmth, pain, burning sensations).

   • If sensation/s is/are mild, REASSURE and continue.

   • If sensations become worse, STOP/DISCONTINUE.

10. At end of treatment the device automatically turns OFF.

11. Remove Tegaderm and wipe device with alcohol wipe.

12. NDCP removes her glasses and removes her patient's face washer or eye mask.

Managing the baby whilst implementing light therapy

• If the mother does not wish for the ‘someone’ to take the baby out of the room, the baby may be held by an accompanying person seated in the room but outside of the nominal ocular hazard distance (NOHD) of the laser device.

• If the mother is unaccompanied, the baby will be placed in the capsule or pram in the treatment room and outside of the nominal ocular hazard distance (NOHD) of the laser device.

• TIf the baby becomes distressed, and the mother wishes this to occur, treatment can be interrupted so that the child can be settled, and treatment re-commenced. The total time of light therapy is still added up to a total of fives minutes, even if there is two minute administration of light, a break, then another three minutes, for example.

Acknowledgements

Dr Pamela Douglas gratefully acknowledges the work of Professor Liisa Laakso from Mater Research, Brisbane, Australia, in the development of this light therapy treatment protocol. Professor Laakso used her expertise in photobiomodulation therapy to help develop the intervention in our planned study on use of laser treatment for lactation-related nipple pain and damage. The steps of this intervention have been adapted here by Dr Pamela Douglas for use in clinics by NDC Accredited Practitioners. The development of the treatment protocol occurred as part of a research collaboration between Dr Pamela Douglas, Professor Liisa Laakso, other health professionals at The Possums Clinic Brisbane Dr Lauren Wilson, Dr Kathryn Franks, Dr Amy Alldis and Mater researchers Monique Ralph, Sheridan Guyatt. The study was disbanded before implementation in March 2023.