As described, (and there are lots of unanswered questions I don't have time
to formulate: that's why Lactnet is not a good place for individual cases
so often) the problem seems to be excessive myo-epithelial contraction in
response to oxytocin. I think I'd talk to an endocrinologist or a
pharmacologist (ask Tom Hale) and experiment with oxytocin antagonists or
smooth muscle relaxants of some sort in small quantities. The nipple
blanching/vasospasm is also very likely to relate to some sort of
excessive/inappropriate muscular contraction. Hyper-innervation?: I think
it likely there are normal numbers of nerve endings but they can't cope
with this degree of spasm. Cramps hurt in ordinary muscles and we don't
suspect there are too many nerve endings, just that muscles are
malfunctioning. Nifedipine or whatever is being used for vasospasm (see
Carolyn Lawlor-Smith's post on this and ask her) might have an effect. As a
general commonsense suggestion of no proven benefit, keep the breast warm
and supported well. Mastitis is probably only obstructive/inflammatory
unless the mother has evidence of breast/nipple lesions. Mind you, the high
pain rating that drops does raise a query re nipple fissure (sometimes
invisible). Read the relevant breast and nipple chapters in Breastfeeding
Matters and get the mother to, then think them through. (Borrow: I'm out of
copies pro tem.)  Of course, this could be mumps mastitis too: same
presentation of extreme pain due to viral infection of glandular tissue
that is contracted down on... Weaning won't help that problem. I doubt that
the fibrocystic disease has much relevance, or the noted sensitivity since
menstruation: both occur in lots of mothers without this sort of
sequel.What else is suggested these days for over-forceful MER, so strong
as to be painful? It is the case that many women experience this painful
letdown early in lactation and it does abate over time. I'd also get her
supply into synch with baby's needs if it isn't already (sounds a bit as
though she could have too much.) And the nipple treatments for thrush can
result in extreme breast pain in some women.. Sorry this is disjointed:
zero time. All the best, MM