As you mention that this pain only happens in the morning after nursing on a 
full breast, I wonder if there might be an excess flow at that time and if baby 
is clamping down or biting to compensate.  Also, possibly damage from baby 
teeth?  If it is consistently the same nipple and occurs after morning feeds, 
perhaps changing the feeding position for that morning feed to accomodate a 
possible rapid flow would help.  If there is Reynauds and nipple damage due to 
clamping/biting was a causative factor, it may be that it will take a few weeks 
of non clamping/biting before mom feels better.

Another thing I might suggest would be to evaluate mom's sleep position to 
see if there is some sort of persistent restriction on that breast with her 
favored sleep position - such as might contribute to a clog if you think that's 
the case.

With unilateral pain, those are the only thoughts I can come up with.

Casey Clubb, RN, IBCLC
Oregon



On Tue, 10 Jun 2008 11:58:47 -0400, Diane Frederick RN,IBCLC 
<[log in to unmask]> wrote:

>To all, 
>I don't post very often, but I am desperate. 
>I have client permission to post her problem as I understand it. 
>Symptoms:
>Mother of 6 month old baby. Persistent, constant, single nipple pain. Nipple 
>feels burned. Breastfeeding on that side is not painful after latching. On the 
>same side every few days a severe burning, stabbing pain radiating into her 
>breast. This pain is only in the morning after nursing on a full breast. It lasts 
2 
>or 3 hours and then is sore for the rest of the day.
>Treatment:  
>Has been through 2 rounds of Diflucan. The first Rx was one pill every three 
>days. (No help, DUH!) Next round was full two weeks of 150 per day. Using 
>topical antifungal also.  Now she has been on Procardia for Raynauds for one 
>week.
>Results:
>None of these treatments have relieved any of her pain. 
>
>Could this be a recurring clogged duct? I recommended she get an ultrasound 
>when her breast is hurting. That will be difficult to schedule. 
>
>What am I missing?
>HELP!
>
>Diane in GA during a record early heat wave.
>
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