Sharon,

This sounds very familar to me, I had the same problem with my first child.  The
only way to describe the pain with let-down was that it felt as if someone was
using crochet hooks on my milk ducts and pulling them out through my nipple.  I
also had a very strong MER and my son would cough and choke and had to pull away
during each nursing.  But the best part of this is that it DOES go away!!  I was
crying on the phone to a LLLL about this (my first contact with LLL) then it
started to improve.  Just tell her to relax as much as possible during the feeds
and in the next few weeks it will start to fade (as the tingling at let-down
usually does over time).  Mine went to slight pain, tingling, then nothing
during let-down (my son also learned how to handle the faster milk flow as he
got older).  This problem did not come back with my second child.  Just give her
a lot of support and let her know that it will end, as do all sensations of
let-down.

Felicia Henry, LLLL & AAHCC
Oxnard, CA