Thought you all might be interested in the resolution of the case I posted about
on 2/7 and 2/12.

To summarize, I received a call at 6 days postpartum from a second time
breastfeeding mother (first child 11 yrs. old, breastfed without difficulty)
complaining of *incredible* burning pain in her breasts.  Pain was constant
although worse during suckling, not associated with MER, no blanching of the
nipple, no significant nipple damage, no engorgement.  She had a weak hx of
yeast (no signs in baby, past vag. yeast infections but not recent, 10 days of
antibiotics during pregnancy + IV antibiotics after c-sec) but since I couldn't
think of anything else it might be and she seemed to be in such pain that I
asked her doc to prescribe fluconazole.  Two days later we added ibuprofen
because the pain was unremitting.  She took the 10 days of fluconazole
(Diflucan) without significant change in symptoms.  She did get some lessening
of pain at the point where she started taking the ibuprofen consistently rather
than sporadically.  When I found out she had fibromyalgia that was diagnosed 4
years ago I started doing more research into that.

It seems virtually certain to me now that her fibromyalgia is the cause of her
burning breast pain.  Since this has been reported nowhere in our literature
that I'm aware of, I thought that you all might like to tuck the info into a
back corner of your brains.  I signed onto a fibromyalgia listserv (geez--an
even busier one than Lactnet!) and posted the case there.  I got quite a few
responses from women with similar burning pain in their breasts, most of whom
were not lactating.  One was from a former LLL Leader who had this pain while
nursing her last child.  An excerpt from her post:  "FM causes burning pain
elsewhere, even everywhere.  It is a searing type of pain, feels as if the top
layer of skin has been scraped off just enough so the nerve endings are exposed,
very raw.  Also, many people with FM report extreme sensitivity to touch, so
much so that even the lightest touch of the softest cloth can cause unbearable
pain during bad flares."  My client's FM had been fairly dormant during her
pregnancy and my best guess is that afterward, with the change in hormones,
weight of full breasts, and constant "touch" of baby's mouth her symptoms kicked
into high gear in her breasts.

For those of you who know as little as I did about this condition, here's just a
bit from _Fibromyalgia--A Physician's Guide_ by David A. Nye, MD that's
available from their listserv:  "Fibromyalgia syndrome (FMS) is an
underdiagnosed disorder of unknown etiology affecting over 5% of the patients in
a general medical practice and an estimated 2-4% of the general population,
women more often than men.  Patients complain that they ache all over.  A large
number of other symptoms are often present, particularly fatigue, morning
stiffness, sleep disturbance, paresthesias, and headaches.  On examination,
areas of focal tenderness called tender points can be demonstrated in
characteristic locations."  In response to my post Dr. Nye noted that "burning
pain in various places is common in FMS."

My client is now one month postpartum and continuing to breastfeed.  She reports
that some days are pretty good and some are awful.  She has continued the
ibuprofen since that seems to help.  Other suggestions that have proven helpful
have been to make sure that her nursing posture is very good--not hunched over
and breasts supported at all times.  Stretching exercises (trying to touch
elbows in the back) have helped to keep chest muscles from becoming tight.  (One
of the women who responded to my query was certain that the cause of her severe
burning breast pain was muscle spasms in the muscles underneath the breast.)  A
couple of people have suggested calcum/magnesium supplements as potentially
helpful, so she will be starting that.  (Specific suggestion:  1000 mg calcium +
300 mg magnesium (in chelated form) + vitamin D daily.  Increase to 1500 mg Ca
and 450 mg Mg when pain flares, if that doesn't help take an additional 400-800
mg of magnesium.  Cautioned against taking huge doses of magnesium for more than
a week or so at a time; can rob body of calcium.)

Hope this can be helpful to someone else.  I run into so many things I can't
figure out that this was kind of rewarding!

Becky Krumwiede, RN, IBCLC, Appleton, WI
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