What is Testicular Pain

Testicular pain, or pain in the testicles, is a relatively common problem in men. It can be acute, i.e. sudden in onset and resolving over weeks or months, or chronic; possibly low-lying but constant and resistant to treatment. This type of pain can have many explanations.

Causes of Testicular Pain

One cause of testicular pain is possible infection of the outer layers of the testicles, known as epididymitis. Inflammation of the testicles, which is called orchiditis, also results in pain. These conditions may be related to a swelling of the prostate, particularly in older men.
Acute pain is often associated with injury to the testicles, which may be either trivial or indicative of a more serious condition, such as testicular torsion. Chronic pain in the testes can be caused by cancers in the prostate, lower back, or the testicles themselves. Treatments intended to remove existing cancers, such as radiation or chemotherapy, may also cause pain in the testicles. This is due to the nerve damage that is often a side effect of these therapies.

Treatment for Testicular Pain

The first-line treatment for testicular pain is conventional oral painkillers. These include ibuprofen, naproxen, anticonvulsants such as gabapentin, antidepressants such as venlafaxine, and opioids as a last resort. The drawbacks of drug use to manage pain are the possibilities of abuse, addiction, and organ or gastrointestinal damage associated with long-term use.

In cases of chronic testicular pain resulting from cancer or cancer treatments, nerve blocks can be used to achieve medium- to long-term analgesia. Nerve blocks are injections of steroids and local anesthetics such as lidocaine, given via needle directly to spinal nerves that are the source of pain. Targeting nerves in the lumbar or sacral regions, which control pain signaling from the testicles may be necessary in controlling chronic pain.

If nerve blocks fail to deliver the expected pain relief, radiofrequency ablation may be employed as a next step. This technique involves the introduction of thin probes through the skin to the relevant spinal nerves. These deliver electro-thermal impulses to destroy the specific parts of the nerve that transmit pain.

Spinal cord stimulators (SCS) are state-of-the-art devices for safe and effective implantation into the back. They are thin wires made of a soft, flexible material. Stimulators may be implanted in a medical facility to assess the response of a patient’s pain levels to the treatment. This device may remain implanted for a few days, so the patient can test its effects. If this trial stimulator is a success, a permanent device may be implanted. The SCS is usually connected to a hand-held controller outside the body. The patient can use it to activate pain-blocking impulses as needed. SCS devices can be placed along the spinal cord in the vicinity of spinal nerves associated with chronic testicular pain.

There are some risks associated with the implantation and use of the SCS, including infection at the site of installation. The implanted wires have a low incidence of causing the accumulation of scar tissue at the location of the wires. Scar tissue can cause additional pain and inflammation in nervous tissue. Bleeding and cerebrospinal fluid release from the incisions made is also possible. The SCS may fail if it does not cover enough of the area controlled by the defective nerves. It may in some cases fail if the electrical signals produce impulses other than pain blocking, which can cause lack of sensation or nerve damage. However, SCS has been shown to be very effective in relieving symptoms of nerve damage such as in chronic testicular damage.

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Testicular pain can have a range of explanations. These include injury and infection, which usually resolve on their own over weeks and months. This is classified as acute pain, and may have a more serious basis such as testicular torsion. In these cases, immediate medical treatment should be sought. If not, conventional oral medications such as naproxen, gabapentin, and codeine may manage the pain until it eases.
Testicular pain in the longer term may indicate prostate enlargement, malignant tumors, or inflammation. This is termed chronic pain. It may be treated by lumbar or sacral nerve blocks, radiofrequency ablation, or spinal cord stimulation. Though it is a distressing condition for men, testicular pain can be successfully treated.

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