To rule in/ out vasospasm ; does exposure to cold worsen pain and warmth relieve discomfort? Just throwing ideas out: have you thought of mammary constriction syndrome? Is the pain particularly associated with let-down? Using breast shells for sore nipples to reduce nipple irritation? 
Best wishes,
Melinda Harris-Moulton ARNP IBCLC. Olympia WA

Sent from my iPad

> On Jul 8, 2015, at 9:03 AM, Holly McSpadden <[log in to unmask]> wrote:
> 
> A culture of her nipples to rule out bacterial infection?
> 
> Holly McSpadden, IBCLC
> 
> Sent from my iPhone
> 
>> On Jul 8, 2015, at 10:34 AM, Wendy Jordan <[log in to unmask]> wrote:
>> 
>> PTP: I have a client who has had persistent sore nipples. At 2 months treatment for thrush included 2 rounds of diflucan,  APNO for 3 weeks, and she tried grape seed extract but it irritated her skin. The soreness significantly decreased but never went away completely. She has returned to work and the pain level is about 4-5 (scale to 10). Assessed for both ULT and PTT neither are an issue and latch is fantastic. She doesn't tend to be sensitive to environmental agents or have eczema. She hasn't changed detergents or soap and doesn't use creams. I have suggested decreasing pressure while pumping and using different flanges but there has to be another underlying cause because she has been sore prior to pumping while at work. The nipples are always red and sometimes the right nipple blanches slightly, though she doesn't feel any throbbing. She also mentioned achiness in the breast during pumping. Any ideas? All suggestions greatly appreciated.
>> 
>> Wendy Jordan, BS, IBCLC
>> Private Practice LC
>> www.seacoastlactation.com
>> 
>>            ***********************************************
>> 
>> 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
> 
>             ***********************************************
> 
> 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

             ***********************************************

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