Roxanne.........that is a tough call.........there have been many occasions when I have had a breastfeeding mom with the same type of  soreness, with no obvious answer to the discomfort she is suffering. It is at that point I refer them on to a lactation-friendly dermatologist. 
I do believe in letting the mother use whatever gives her the greatest relief, unless, of course, I have a better suggestion. It sounds as if you have ruled out alot of the obvious things.
I would also think along the lines of contact dermatitis, and/or what type of bra does she wear?  Is it nylon? Did she sleep in it while she was pregnant? 
Perhaps it would be prudent to have her gently wash her nipples with a mild soap such as Cetaphil, pat them dry, and then apply the gel pads. 
I wasn't sure from your post if she is using Lansinoh or not. If she is, I would have her d/c that immediately. It may or not be contributing to the problem, but until you know what it is, I would stick to the Lotrimin AF. 
Good luck! Hope some of this has been helpful!
Sandey Stayanoff, RN, IBCLC, RLC
Northside Hospital, Atlanta, GA (where 18,000 babies were born last year!)
 
 







All you need is love......

 
Sandey 



































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