# Do Lactating Mothers’ Descriptions of Breastfeeding Pain Align with a Biopsychosocial Pain Reasoning Tool? A Qualitative Study

## TL;DR

This study explores how lactating mothers describe breastfeeding pain and whether their experiences align with a biopsychosocial pain model.

## Contribution

The study introduces a new perspective on lactation pain by linking mothers' qualitative experiences to a clinical reasoning tool.

## Key findings

- Breastfeeding pain aligns with the BPRM domains of local stimulation, external influences, and central modulation.
- Participants did not recognize psychosocial factors influencing pain perception.
- New themes of motivation and expectations emerged from inductive analysis.

## Abstract

Background/Objectives: Despite the intent of most mothers to breastfeed their children, breast or nipple pain can be the reason for early cessation of breastfeeding. Current understanding about lactation-related pain revolves around mechanical or pathological causes, discounting the role of psychosocial factors which can influence management of pain. The Breastfeeding Pain Reasoning Model is a clinical reasoning tool developed to support those evaluating women’s lactation-related pain. We aimed to explore perspectives of breastfeeding women on lactation-associated pain and determine how they align with the Breastfeeding Pain Reasoning Model (BPRM). Methods: We conducted a qualitative descriptive study using phenomenological approach in Singapore. Eighteen women with recent breast and/or nipple pain during lactation underwent individual semi-structured interviews in 2022. Thematic analysis was performed. Results: Deductive analysis showed that lactation-associated pain was aligned with BPRM’s domains (i.e., local stimulation, external influences, and central modulation). Psychosocial factors likely influencing central processing of pain were not recognised by most of the participants. Participants described severe breastfeeding pain often accompanied by feelings of vulnerability, injustice, and uncertainty. Inductive analysis identified two additional themes of motivation and expectations. Conclusions: Greater awareness of the interplay between the broad influences on pain is needed. Using an interoceptive lens could help to illustrate how signals from the breast inform the brain, and how social, emotional, and cognitive factors influence the individuals’ perception of painful experiences. Educating breastfeeding women and healthcare personnel about the biopsychosocial nature of pain may empower women to better navigate the challenges of breastfeeding and improve breastfeeding outcomes.