What Is Testicular Pain?

Pain in the testicles, or testicular pain, is a relatively common condition in men that can be the result of several different causes. The pain can be acute, or starting suddenly and resolving over a couple weeks or months, or it can be chronic in nature. In some cases the pain can be low intensity and it can be resistant to treatment. The cause of pain will determine the treatment options available and the potential that the pain can be successfully managed.

Causes Of Testicular Pain

Several causes for pain will include the possibility of infection in the outer cellular layer of the testicles, also called the epididymis. The infection is referred to as epididymitis. Inflammation or infection of the testicles, also causing pain in the testicles, is called orchiditis. In some cases, these conditions are related to swelling in the prostate, particularly in older men.

Acute pain may also be associated with injury to the testicles. Injury can be inconsequential or it can indicate a more serious condition; for example, testicular torsion in which the testicles twist within the scrotum, strangulated inguinal hernia, or testicular tumor with infection, infarction, or rupture. Chronic pain in the testes can be the result of cancers located in the prostate, lower back, or in the testicles. Treatments for acute or chronic pain in the testicles begin with an assessment for the cause. Removal of cancers using radio-therapy or chemotherapy can also cause pain in the testicles related to nerve damage, a side effect of the treatment.

Treatments For Testicular Pain

Once the cause of testicular pain has been addressed, or assessed, the physician may begin with conventional medical treatments, which usually includes oral painkillers. These oral pain medications include naproxen, ibuprofen, antidepressants (venlafaxine), anticonvulsants (gabapentin), or opioids as a last resort. There are side effects to using medications, which include organ damage from long-term or excessive use, drug addiction, drug tolerance, or gastrointestinal damage with prolonged use. Pain medications are used to reduce the symptoms of pain but do not address the underlying cause of the condition which must also be addressed to permanently alleviate the pain.

Individuals who suffer with chronic pain from cancers or cancer treatments may experience successful pain reduction using nerve blocks. These can achieve medium- to long-term numbing. Injections of local anesthetic and steroids directly to the spinal cord nerves responsible for the pain will result in immediate pain relief. In order to control the pain, the nerve block injections will be done in the lumbar or sacral region which controls the electric impulses that transmits pain signals to the brain from the testicles.

If a nerve block fails to control the pain, the physician may recommend radiofrequency ablation. During a radiofrequency ablation procedure the physician uses a local anesthetic to numb the treatment area, prior to inserting a thin probe through the skin to the spinal nerves that are responsible for the conduction of pain. The probe then delivers electro-thermal impulses that destroy the nerves responsible for the transmission of pain. Risks associated with the procedure include infection, bleeding, and unintentional damage to the motor nerves that will result in paralysis.

Another choice for pain control is a spinal cord stimulator (SCS), which is a state-of-the-art medical device considered when other more conservative methods have not been successful. These devices are safe and effective. Two types of spinal cord stimulators might be considered, both of which use thin wires made of flexible material to conduct electrical impulses to the spinal cord nerves that transmit the pain perception to the brain. The stimulator is implanted at a medical facility, often as an outpatient procedure. A trial stimulator is used to assess the efficacy of the procedure over several days to several weeks. If treatment with the temporary device is a success, a more permanent device is implanted. The patient uses an external hand-held controller to deliver the pain-blocking impulses to the nerves responsible for the chronic testicular pain. The SCS devices are very safe and can be easily removed in an outpatient procedure if the pain resolves or the machine malfunctions.

The risks associated with using a spinal cord stimulator include infection where the device is installed. Patients might also experience the development of scar tissue around the implanted wires that will cause additional inflammation and pain. During implantation of a spinal cord stimulator patients might also experience bleeding or leakage of cerebrospinal fluid from the area of the incision. Leakage of cerebrospinal fluid can cause other symptoms and conditions that require medical attention. If the electrode placement for the stimulator does not cover enough of the area, the treatment may fail. Although there are risks, the device has been very effective in reducing or eliminating chronic testicular pain.

Conclusion

Testicular pain can occur due to a number of reasons. These include injury, infection, testicular torsion or infarction, rupture or infection related to a varicocele, or hydrocele. Conventional medical treatment for the pain may include naproxen, gabapentin, or codeine to manage the pain. Over the long-term, chronic testicular pain can point to prostatic inflammation, enlargement, or malignant tumors. These chronic pain conditions may be treated with nerve blocks in the lumbar or sacral spine areas, radiofrequency ablation, or spinal cord stimulation. Although painful and distressing, most testicular pain conditions are treated successfully.

References

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