Dear Pat,
Have you thought about vasospasm as a cause of this lady's problems.
Burning is very typical of the pain some women get with vasospasm. Does she
get colour changes in her nipple with the pain? In particular does she
describe the classic biphasic (white then red or white then blue) or
triphasic (white, then blue and then red) colour changes associated with
the vasospasm of Raynaud's phenomenon.
Thrush and vasospasm seem to often co-exist. Maybe the pain associated with
thrush leads to overstimulation of the autonomic nervous system which leads
to the vasospasm.
If you think it may be vasospasm how about trying some nifedipine. My
sister Carolyn and I have recently published five cases of vasospasm
affecting the nipples of breastfeeding women successfully treated with
nifedipine. (Lawlor-Smith LS, Lawlor-Smith CL. Raynaud's Phenomenon of the
Nipple: A preventable cause of breastfeeding failure? MJA 1997;166:448)
Laureen Lawlor-Smith
BMBS IBCLC
South Australia