Jan, 

Would also look at possible candidiasis (burning in breast; raw feeling nipple) and vasospasm (white blanching on the nipple intermittently).   Am including a link to the Academy of Breastfeeding Medicine's Protocols - - please see ABM Protocol #26 on Persistent Pain with Breastfeeding.  Am grateful to see that several of the ABM Protocols are now listed in as many as six languages.  https://www.bfmed.org/protocols

The manufacturer's labeling for ibuprofen 200 mg tablets advises: "Do not exceed six tablets in 24 hours, unless directed by a doctor", which is a daily total of 1,200 mg.  This mother's physician is advising her to take twice that much at 800 mg q 8 hours for a daily total of 2,400 mg.  The current high dosing of ibuprofen for pain must be making it difficult to fully assess her pain.  I agree that this mother needs help to quickly resolve her breast and nipple pain.  Please keep us posted.     

Jan's post: 
"Permission to post: working with a mother of a 3-month-old infant who presented to her MD 2+ weeks ago with SEVERE burning pain in the superior portion of her L breast. No fever, redness, swelling or firmness of breast. She was put on Augmentin for 2 weeks and the burning stopped. She finished the prescription 3 days ago and she has started to have intermittent burning again in the breast with a raw feeling nipple. Her milk supply did not decrease during this episode. Pumping is the only thing that relieves the burning. Infant continues to nurse one side each feeding q 3 hours on the weekends. Mom pumps q3 hours while away from her at work. She was not on antibiotics previous to the first episode. I instructed her to continue 800 mg ibuprofen q 8 hours (as instructed by MD) for a few more days, try heat on the breast when burning is starting (has noticed an area of white blanching on nipple intermittently) and considered lecithin, in case it is a plugging problem. I am wondering about a possible resistant bacteria and I am wondering if there's a standard protocol for culturing milk to r/o staph that I could share with her MD? I appreciated any suggestions."

With best regards,

Debbie

Debra Swank, RN BSN IBCLC
Ocala, Florida USA
MoreThanReflexes Education
http://www.MoreThanReflexes.org

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