It is impossible to have much of an opinion without actually seeing this 
nipple, and I feel like I say the same thing now every time I post...but it 
could be vasospasm causing her continued pain.

I see a LOT of mothers with pain for weeks and weeks duration before they 
see me...fo all sorts of reasons.  This mom had poor latch initially, then 
perhaps yeast overgrowth, and now perhaps purposeful pinching to control 
fast flow...all reasons for nipple pain +/- deep shooting pains after 
feeding.

BUT---even if all of the above is fixed, the spasm can keep itself going. 
It appears (ie no research) that in a susceptible person if spasm continues, 
the tissue is hypoxic for a period of time during the spasm, causing more 
tissue damage, leading to continued spasm.  SO you have to break the 
viscious cycle of spasm to get the pain to go away. HEAT is by far the most 
effective way to do this...a heating pad on the "Low" setting works 
best...applied immediately after nursing or pumping for at least 5 minutes 
causes the vessels to open wider, not clamp down.  It is VERY important to 
do this after every single feeding for a few days in a row to allow the 
tissues to heal, and thus very important the mom understand why it is 
necessary to do this extra thing.

Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE

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