Chronic testicular pain. A workup and treatment guide for the primary care physician.

Chronic pain syndromes are encountered in every medical practice, and workup can be costly and frustrating. Patients with chronic testicular pain were once referred early to urologists but are now being seen and successfully treated in primary care offices. Referral is usually reserved for diagnosis of questionable testicular masses and for surgery. Antibiotic therapy, often combined with a nonsteroidal anti-inflammatory drug, may be useful--in some cases even when infection has not been identified. Spermatic cord block and transcutaneous electrical nerve stimulation may help relieve pain, although it often recurs. Antidepressants sometimes relieve pain and alleviate the psychogenic symptoms that may accompany it. Many patients benefit from a program at a multidisciplinary pain-management clinic and should complete one before opiate therapy is prescribed. When all conservative efforts have failed and testicular pain continues to diminish the patient's quality of life, orchiectomy may have to be considered. In general, however, we recommend that surgery be undertaken only when a pathologic condition is found and not for pain relief alone.