Chronic orchialgia in the pain prone patient: the clinical perspective

Chronic pain syndromes are well known to the medical community. The incidence of chronic pain syndromes and cost of evaluating these patients are rapidly increasing. Chronic testicular pain is a fairly common manifestation of a chronic pain syndrome. Retrospectively, we reviewed the records of 48 patients with chronic testicular or scrotal pain (greater than 6 months) evaluated at our institution during the last 7 years. These patients had multiple diagnostic and interventional procedures with few positive findings. There was little improvement in these patients after multiple surgical procedures. Based on the paucity of objective clinical findings a carefully directed diagnostic evaluation for orchialgia is outlined. The treatment of these patients is best managed by a multidisciplinary approach involving the urologist and a pain clinic environment. We believe that extensive diagnostic testing is not indicated in the absence of clinical findings and may serve to worsen the condition or lead to iatrogenic injury. Surgical intervention should be limited to cases when a clear indication is present.