"Ironically, I feel less pain when I'm engorged and DD feeds really well and quickly! My LC said the vasospasm can effect let down though so that may explain why things are easier when I'm full - my boobs have no other option but to let down! Lol!"

that's kind of what I was wondering. If you express a tiny bit - not to relieve engorgement but just to get things flowing - then DD will not have to do the really hard sucking that is typical of a hungry baby trying to get a letdown.
Yeah, I've tried that too. It's still agony on my nipples. And the throbbing breasts start once she is off. Often the opposite side starts throbbing while I'm feeding with the other side. It's evil!

OP - thanks love. I might call the ABA tomorrow for a chat. I don't think there is much else they could suggest though, I'm even using their breast warmers! But you never know, they may have some additional tricks up their sleeves.

Surprised - I had been expressing pretty much full-time from NYE til the Tuesday just gone and it was going really well but I just can't keep it up. I find it far too stressful to feed DD2 and express while trying to entertain DD1. I just feel so tied to the pump and like I have no time for either of my girls. I think if that ends up being my only option, I'll have to throw the towel in. As much as that breaks my heart