What is it about?
Chronic orchialgia can be the result of pathological processes of the scrotal contents or stem from non-intrascrotal structures. Successful pain management depends on identifying the source of localized or referred pain. This is a case report of a 39-year-old male sports coach who presented with low back pain, right orchialgia, and sciatica refractory to conservative management. Magnetic resonance (MR) imaging revealed disc protrusion at L3/L4 and L4/L5 levels. Positive outcomes in relieving back and testicular pain were obtained after a total of 30 chiropractic sessions over a 9-week period. The evidence of the subjective improvement was corroborated by regression of the herniated discs documented on the repeat MR imaging. While chronic orchialgia is not an uncommon problem for men of all ages, it has seldom been described in association with lumbar discogenic disease. The current study provided preliminary support for a link between orchialgia and lumbar disc herniation. Chiropractic manipulation had provided a mechanistic alleviation of noxious lumbar stimuli, leading to symptomatic and functional improvements.
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Why is it important?
Chronic orchialgia may be attributed to a complex interplay between peripheral and central nociceptive mechanisms. Recognizing the factors contributing to testicular pain and dysfunction in patients can be challenging. Treatment strategies for chronic orchialgia have begun to shift toward musculoskeletal dysfunction, a possible overlooked contributor to pain and testicular symptoms. The chiropractic manipulation may have the potential to alleviate this issue by releasing compression of the original nociceptive stimulus.
Perspectives
A 39-year-old sports coach complained of constant low back pain with associated episodic right testicular pain for nearly a decade. He denied any prior trauma or systemic diseases. As a professional fencing competitor, the patient engaged in weightlifting, swimming, and hiking in the past 14 years. He started to experience a worsening back pain with radiating right testicular pain after a backpacking trip 7 years prior to seeking chiropractic treatment. The pain could be elicited by squat lifting, butterfly stroke swimming or coughing. A scrotal Doppler ultrasonography performed at initial urological consultation excluded trauma and direct testicular pathologies. Magnetic resonance imaging (MRI) performed for the orthopedic workup 2 years prior to chiropractic treatment revealed degenerative spondylitis of the lumbar spine. Oral medications (ibuprofen and 10 days of oral doxycycline), sports physiotherapy, and acupuncture did not provide any effective or long-lasting symptomatic improvement. His symptoms significantly worsened in the last 2 months, accompanied by radiating pain down the right leg, which he had not experienced previously. The painful symptoms had a considerable impact on his physical, emotional, sexual, and social functions, and he was unable to continue coaching fencing.
Dr Eric Chun-Pu Chu
New York Medical Group
Read the Original
This page is a summary of: Chronic Orchialgia Stemming From Lumbar Disc Herniation: A Case Report and Brief Review, American Journal of Men s Health, May 2021, SAGE Publications,
DOI: 10.1177/15579883211018431.
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