CHRONIC TESTICULAR PAIN - A WORK-UP 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 an d successfully treated in primary care offices. Referral is usually re served for diagnosis of questionable testicular masses and for surgery . Antibiotic therapy, often combined with a nonsteroidal anti-inflamma tory 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. Antidepre ssants sometimes relieve pain and alleviate the psychogenic symptoms t hat may accompany it. Many patients benefit from a program at a multid isciplinary pain-management clinic and should complete one before opia te therapy is prescribed, When all conservative efforts have failed an d testicular pain continues to diminish the patient's quality of life, orchiectomy may have to be considered. In general, however, we recomm end that surgery be undertaken only when a pathologic condition is fou nd and not for pain relief alone.