Hi Maureen,
    I sort of think of ductal thrush as a "mastitis" caused by yeast.  You're
right, sometimes the most aggressive treatment doesn't make the pain go away.
 I do think that this is from an inflamed nerve.  I've also seen it when
someone's had a horrible latch which causes deep crevice-like wounds in her
nipple(not when there's been damage to the areola), and even as the latch is
corrected, she may still have a shooting pain while breastfeeding, less so,
but still there.  Some of these women have already had treatment for yeast.
I think that the nerves in the nipple are just very damaged or irritated from
the bad latch.  When I see this, I tell them it'll probably take around three
weeks to feel better(really just based on my observations, nothing else) and
to use Ibuprofen and ice on the nipples before,if they want(once they've got
the latch down well).  The reports I get back from the moms confirm this
amount of time.  It also takes nearly that amount of time to heal some of
these deep wounds!
If these wounds were anywhere but the nipple, they'd probably be sutured!
Yuk!
Thanks for bringing this subject up.  I'ts interesting.   Maureen Allen

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