Hi Kika, This doesn't specifically reply to your question on lactnet. However, you mentioned elimination of other causes, including referred pain from nipple trauma. I would like to add another cause of referred pain as a factor in persistent breast pain in lactating women. That is, a history of a spinal injury. If it is in the region which the enervation of the breast comes off, that is more obvious, but my experience is that past injury to other areas of the spine can occasionally be implicated. Postural change is likely to be one of the factors - late-pregnancy postural changes, then delivery, and then the position the mother uses for breastfeeding if she is hunching forward (as some do). That's not the whole story, of course, and perhaps someone will explore whether there is a hormonal link, such as oxytocin surge. However, it has been interesting to find in some puzzling cases of severe and generalised breast pain, that there is an association with past spinal trauma. I send the mother back to whoever was treating her for her pain after the injury, for attention to pain relief, and ask her to come back to me after that. She is unlikely to concentrate on the breastfeeding consultation with a high level of pain, but once that is addressed she and I can make progress. Yes, there are some cases of chronic, severe breast pain that really challenge us as regards finding a solution, even when 7-8 possible causes have been eliminated, including the possibility that it is multi-factorial. (I am in the process of moving house, to a neighbouring city.) Virginia Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA Private Practice IBCLC Queensland, Australia *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome