After such long and consistent treatment for thrush without improvement in
symptoms, it is possible that yeast is not the culprit. For moms with
chronic nipple burning or itching, other things to add on or consider
include changing their nursing pad type, using hobbit/breast shells at night
to prevent nipple pressure/folding, using hydrogel for comfort, stopping all
creams/ointments/lanolin/GV (some of which can cause drying, irritation or
an allergic sensitivity), a trial of ibuprofen (400 - 600 mg (with food)
every six hours around the clock for 72 hours as an anti-inflammatory agent.

Also high on my radar at this point might be assessing for vasospasm: 
From the excellent article: "Raynaud's Phenomenon of the Nipple: A Treatable
Cause of Painful Breastfeeding":

Because the breast pain associated with Raynaud's phenomenon is so severe
and throbbing, it is often mistaken for Candida albicans infection. It is
not unusual for mothers who have Raynaud's phenomenon of the nipple to be
treated inappropriately and often repeatedly for C albicans infections with
topical or systemic antifungal agents. Eight of our 12 mothers and their
infants received multiple courses of antifungal therapy without relief
before the diagnosis was made.
(Entire article at:
http://pediatrics.aappublications.org/cgi/content/full/113/4/e360 )

Remember also that though Raynaud's is a physiologic circulatory condition
of the capillaries, a similar nipple response can be seen with babies who
clamp on the nipple, restricting blood flow to the nipple and causing the
same symptoms and pain.

Best,
Nancy

Nancy Holtzman RN BSN IBCLC
Director of Early Parenting Programs
Isis Maternity
www.isismaternity.com 

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