Have you investigated overactive MER as the cause? Very often an overactive
letdown can be quite uncomfortable.
Does the baby do a lot  of gulping and sputtering on the breast? Does s/he
have green stools or frequent tummy aches? Does mom's milk spray  or eject
forcefully? Does she leak a lot and suffer frequent plugged ducts?

These are all symptoms of Overactive ejection reflex. I wrote an article on
the subject in 96 or 97 for Leaven and it is available on the LLL website.

Usually what I do is put the mom on a 3-4 hour on one breast cycle, baby
can have the breast as often as s/he wants, but the same br is used for the
3-4 hour period. A small amount can be expressed form the other side if the
mother becomes engorged. At the end of the 3-4 hour time, mom starts using
the OTHER breast FIRST removing the baby during the first letdown of each
nursing session. The milk is directed into a cloth diaper and the mom
reattaches the baby after the letdown. This is continued for as long as the
symptom presents itself.
                This technique may "tame" the mother's ejection and balance
the hind milk and foremilk. The baby should still be having the requisite
no. of wet and poopy diapers. If the baby's output decreases, go to one
breast per feeding and nurse VERY frequently. If the mother goes too long
between feedings her ejection will be even more painful.
            Warm compresses, before and after nursing and an anti-
inflammatory or narcotic analgesic is often used until mom is more
comfortable.

 Mary Jozwiak IBCLC
 Private Practice, LLLL, AAPL

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