Chronic pain in testicle

Maybe it’s a nerve issue? Maybe a physiatrist can help or PT for pelvic floor issues.

Hi Jenatsky,
Thanks for your reply.
Doctors have checked out nerves. Had a procedure for nerves, but unfortunarely didn't work.
Also have done 1,000's of pelvic floor excercises, which helps somewhat, but have not alleviated the pain.

You didn’t mention a physiatrist and have you considered acupuncture?

Hello, I've had off and on left side testicle pain for years. Doctor at one point suggested maybe cutting the nerves if I understood correctly. That wasn't for me. I had stopped drinking coffee and noticed my pain went away. I'm not saying caffeine causes it because later on I am now having other pelvic pain that doctors are looking at. I probably have a nerve problem in that area. Just a suggestion.

Hi, Thanks for your response.
I don't drink coffee or any caffeinated drinks. But I appreciatevyour comment.
Best to your with your nerve sensitivity.

I'm very sorry for what you are going through.

Have you talked with your doc about gabapentin (Neurontin). This is usually prescribed for nerve pain in the foot, but nerve pain is nerve pain, I think.

When I had a very arthritic hip, the pain was most keen in my groin. I used an ice gel pack. Not the greatest place for ice, but hey, maybe worth a try.

Sorry I don't have more for you. I haven't heard of this before, which probably means now it will happen to me!

Take care of yourself.

Joe

I found this online:

onservative therapy includes heat, ice, scrotal elevation, antibiotics, analgesics, NSAIDs, antidepressants (doxepin or amitriptyline), anticonvulsants (gabapentin and pregabalin), regional and local nerve blocks, pelvic floor physical therapy, biofeedback, acupuncture, and psychotherapy for at least 3 months. While conservative therapy has almost always been considered first-line treatment, success is relatively poor ranging from 4.2% to 15.2% in some studies. There are no good, published studies regarding reliable non-surgical interventions. Nevertheless, it is advisable to try conservative therapies first.

Treatment starts with dietary and lifestyle advice usually consisting of eliminating dietary caffeine, citrus, hot spices, and chocolate as well as avoidance of constipation and prolonged sitting.

Antibiotics prescribed are usually trimethoprim/sulfamethoxazole or a quinolone because of their lipid solubility. They are typically prescribed for 2 to 4 weeks. Antibiotic therapy is not recommended for empiric use, only if there are objective signs or a reasonable suspicion of an infection.

Initial pharmacological therapy is usually with non-steroidal anti-inflammatory drugs (NSAIDs). They are typically prescribed for at least 30 days. Preferred agents include 600 mg ibuprofen 3 times daily, naproxen (Naprosyn), celecoxib 200 mg daily or piroxicam (Feldene) 20 mg daily. Recurrence rates after successful NSAID use are as high as 50%. Narcotic analgesics should be avoided except possibly for occasional breakthrough pain. There is some evidence than tamsulosin may be of some use in selected patients.

Tricyclic antidepressants work by blocking the reuptake of norepinephrine and serotonin in the brain. Their analgesic effect is thought to be due to inhibition of sodium and L-type calcium channel blockers in the dorsal horn of the spinal cord. Tertiary amines in this class (amitriptyline and clomipramine) are more effective for neuropathic pain than secondary amines (desipramine and nortriptyline) but are also more sedating and more likely to be associated with postural hypotension. They are usually given as a single dose at bedtime and will typically require at least 2 to 4 weeks for their effectiveness to become apparent although this may take up to 8 weeks. Usual dosing is amitriptyline 25 mg at HS.[20]

If tricyclic therapy is not successful after 30 days, the next conservative therapy approach would be to add an anticonvulsant such as gabapentin (Neurontin) at 300 mg TID and pregabalin (Lyrica) at 75 to 150 mg daily. Usually, gabapentin is used first as insurance coverage often requires a gabapentin failure before pregabalin will be covered. These are recommended due to their proven efficacy in neuropathic pain and their relative lack of side effects. They work by modulating the N-type calcium channels which significantly affects pain fibers. Typical dosage of pregabalin for pain control would be 75 mg 3 times daily. If the pain persists beyond 30 days, the treatment would be judged ineffective. In one small study, over 60% of patients with idiopathic chronic orchialgia showed significant pain relief, but large-scale, definitive studies are lacking.

Trigger point dry needling was recently found to be effective in 85% of patients with chronic orchialgia. For those patients who responded, the average number of dry needling treatments was 4.6 while this increased to 6.5 for those who did not respond.

Pelvic floor physical therapy is useful for those with pelvic muscle dysfunction or identifiable myofascial trigger points. In properly selected patients, about 50% have noted improvement in their pain after 12 sessions. It also appears that physical therapy can improve pain and quality of life scores for chronic orchialgia patients even after other treatments. Therefore, a physical therapy evaluation and treatment should be considered an effective, low risk therapeutic option for patients with chronic orchialgia.[21]

The next step is the spermatic cord block which is recommended prior to performing any invasive or irreversible surgical procedures. This is usually done by injection 20 mL of 0.25% bupivacaine without epinephrine using a 27 gauge needle. Steroids may or may not be added. The injection is done directly into the spermatic cord at the level of the pubic tubercle. Ultrasound can be used to assist if the anatomy is challenging due to body habitus or prior surgery. If spermatic cord nerves are involved in the pain signals, the testicular discomfort should be rapidly relieved by the injection. While this often provides relief, it is rarely long term. Those patients who experience more than 90% pain relief can be offered repeated blocks up to every 2 weeks. If the injection provides no pain relief, it is not repeated. If the spermatic cord block is not at least 50% successful in reducing the orchialgia, consider a possible missed diagnosis. A re-examination of the patient along with a careful review of his laboratory studies and imaging is suggested. In general, the better the response to the spermatic cord block, the better the outcome with MDSC. The use of "sham blocks," with normal saline instead of local anesthetic, is discouraged due to ethical considerations.[22]

Surgical intervention is indicated if the spermatic cord block is at least 50% successful in reducing the orchialgia.