Of course there can be hormonally-related nipple pain.  Many pre-menstrual
woman notice it, and it is a common early signal to a nursing mother of a
new pregnancy. Pre-menstrual pain is typically during the luteal phase of
the menstrual cycle.  This phase is inhibited during lactation, so I can't
work that out with postpartum breast sensitivity, unless it is the abrupt
hormonal shift from the high estrogen/progesterone phase and the drop to the
secretory phase that causes the pain.  That would, indeed, mimic the
hormonal milieu immed. pp.
  There are probably other mechanisms related to pp breast and nipple pain
that we haven't considered, too.  For instance, the lymphatics of the breast
are complex.  Lawrence points out that  "The lymph drainage of the breast
consists of the superficial or cutaneous section, the areola and the
glandular or deep-tissue. Other points of drainage are to pectoral nodes
between the pectoralis major and minor muscles and to the subclavicular
nodes in the neck deep to the clavicle. Some transmammary lymph drainage
occurs to the opporite breast as well as to the subdiaphragmatic
lympatics..." I have sinus problems sometimes, and when I experience
inflammatory sx as a result, the lymph nodes in my cheeks and lower face and
neck sometimes get so tender.  This can happen without an actual infection,
or at least without my having a fever. With all those nodes in the breast,
maybe some get really tender trying to handle all the excess fluid, all the
pressure, and perhaps (due to slightly surpressed immune function) are
overwhelmed processing wastes.

Also, the nerves of the breast -- esp. those in the  areola --  influence
the mammary blood supply.  Therefore, they innervate the smooth musculature
of the inner glandular blood vessels.  This is just about the only supply of
nerves to the inner gland.   Lawrence suggests "They may correspond to
sensory fibers for sensing milk pressure."  It would make sense that, during
engorgement, when we expect ductal distension due to increased milk
pressure, these sensory receptors in the blood vessals might be irritated.
So I think there may be reasons to suggest that the first week or so of
lactation might be somewhat more or less uncomfortable as everything settles
in. So even if mom and baby have perfect latch technique, there may be some
tenderness.  However, pain beyond a certain level prob. indicates some
escalation of problems which requires a judicious early intervention before
any unfortunate cascade of complications can ensue.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html