Eric Chun Pu Chu 1, Arnold Yu Lok Wong 2
Affiliations
PMID: 34027733
PMCID: PMC8141999
Free PMC article
Abstract
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.
Keywords: chiropractic; discogenic disease; lumbar disc herniation; orchialgia; testicle.
Conflict of interest statement
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Figures
Figure 1.
Comparison of two MR scans…
Figure 2.
Proposed pathways for discogenic pain…
Similar articles
Taming of the Testicular Pain Complicating Lumbar Disc Herniation With Spinal Manipulation.
Chu ECP.Am J Mens Health. 2020 Jul-Aug;14(4):1557988320949358. doi: 10.1177/1557988320949358.PMID: 32772625 Free PMC article.
Alagha B.J Back Musculoskelet Rehabil. 2015;28(3):603-7. doi: 10.3233/BMR-140557.PMID: 25391323
Familial predisposition for lumbar degenerative disc disease. A case-control study.
Matsui H, Kanamori M, Ishihara H, Yudoh K, Naruse Y, Tsuji H.Spine (Phila Pa 1976). 1998 May 1;23(9):1029-34. doi: 10.1097/00007632-199805010-00013.PMID: 9589542
Intradural Lumbar Disc Herniation: A Case Report and Literature Review.
Ge CY, Hao DJ, Yan L, Shan LQ, Zhao QP, He BR, Hui H.Clin Interv Aging. 2019 Dec 23;14:2295-2299. doi: 10.2147/CIA.S228717. eCollection 2019.PMID: 31920293 Free PMC article. Review.
Lumbar disc herniation in early childhood: case report and literature review.
Martínez-Lage JF, Fernández Cornejo V, López F, Poza M.Childs Nerv Syst. 2003 Apr;19(4):258-60. doi: 10.1007/s00381-003-0720-6. Epub 2003 Mar 7.PMID: 12715195 Review.
See all similar articles
References
Alexander C. E., Varacallo M. (2020). Lumbosacral radiculopathy. In: StatPearls, StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430837/
Arendt-Nielsen L., Svensson P. (2001). Referred muscle pain: Basic and clinical findings. Clinical Journal of Pain, 17(1), 11–19. doi:10.1097/00002508-200103000-00003. – DOI – PubMed
Asadian L., Haddadi K., Zare A. (2016). Upper lumbar disk herniation presenting as chronic abdominal and scrotal pain: A case report. Neurosurgery Quarterly, 26(2), 177–179. doi:10.1097/WNQ.0000000000000162 – DOI
Chaban V. V. (2010). Peripheral sensitization of sensory neurons. Ethnicity & Disease, 20(1 Suppl 1), S1-3-6. PMID:20521376 – PMC – PubMed
Chu E. C. P. (2020). Taming of the testicular pain complicating lumbar disc herniation with spinal manipulation. American Journal of Men’s Health, 14(4), 1557988320949358. doi:10.1177/1557988320949358 – DOI – PMC – PubMed
Cramer G. D. (2014). The lumbar region. In: Cramer G. D., Darby S. A, Clinical Anatomy of the Spine, Spinal Cord, and ANS (3rd ed., pp. 246–311). Elsevier. 10.1016/B978-0-323-07954-9.00007-4 – DOI
Das G., Roy C. (2018). Rami communicans fibers in discogenic low back pain: The controversies. Indian Journal of Pain, 32(2), 60-62. doi:10.4103/ijpn.ijpn_48_18 – DOI
Doubleday K. L., Kulig K., Landel R. (2003). Treatment of testicular pain using conservative management of the thoracolumbar spine: A case report. Archives of Physical Medicine Rehabilitation, 84(12), 1903–1905. doi:10.1016/s0003-9993(03)00283-1 – DOI – PubMed
Dubový P. (2011). Wallerian degeneration and peripheral nerve conditions for both axonal regeneration and neuropathic pain induction. Annals of Anatomy, 193(4), 267-275. doi:10.1016/j.aanat.2011.02.011. – DOI – PubMed
Edgar M. A. (2007). The nerve supply of the lumbar intervertebral disc. Journal of Bone Joint Surgery, 89B(9), 1135-9. doi:10.1302/0301-620X.89B9.18939 – DOI – PubMed
Jinkins J. R. (2004). The anatomic and physiologic basis of local, referred and radiating lumbosacral pain syndromes related to disease of the spine. Journal of Neuroradiology, 31(3), 163-180. doi:10.1016/s0150-9861(04)96988-x – DOI – PubMed
Leone J. E., Middleton S. (2016). Nontraumatic testicular pain due to sacroiliac-joint dysfunction: A case report. Journal of Athletic Training, 51(8), 651-657. doi:10.4085/1062-6050-51.10.06 – DOI – PMC – PubMed
Leslie S. W., Sajjad H., Siref L. E. (2020). Chronic testicular pain, orchialgia. In: StatPearls, StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482481/
Levine L. A., Abdelsayed G. A. (2018). Chronic scrotal content pain: A diagnostic and treatment dilemma. Journal of Sexual Medicine, 15(9), 1212–1215. doi:10.1016/j.jsexm.2018.07.008 – DOI – PubMed
Murata Y., Kato Y., Miyamoto K., Takahashi T. (2009). Clinical study of low back pain and radicular pain pathways by using L2 spinal nerve root infiltration. A randomized, controlled, clinical trial. Spine, 34(19), 2008–2013. doi:10.1097/BRS.0b013e3181b1fb96 – DOI – PubMed
Neff S. M., Warnecke R. (2017). Chiropractic management of low back pain and testicle pain: A case report. Journal of the Academy of Chiropractic Orthopedists, 14(3), 36–41.
Parekattil S. J., Ergun O., Gudeloglu A. (2020). Management of chronic orchialgia: Challenges and solutions– The current standard of care. Research and Reports in Urology, 2020, 199–210. doi:10.2147/RRU.S198785. – DOI – PMC – PubMed
Patel A. P. (2017). Anatomy and physiology of chronic scrotal pain. Translational Andrology and Urology, 6(Suppl 1), S51–S56. doi: 10.21037/tau.2017.05.32 – DOI – PMC – PubMed
Peng B., Li D., Pang X. (2014). Degenerative lumbar spondylolisthesis with testicular pain. Pain Medicine, 15(1), 169–170. doi:10.1111/pme.12246. – DOI – PubMed
Rowell R. M., Rylander S. J. (2012). Low-back pain, leg pain, and chronic idiopathic testicular pain treated with chiropractic care. Journal of Alternative and Complementary Medicine, 18(4), 420–422. doi:10.1089/acm.2010.0698 – DOI – PubMed
Sanvictores T., Tadi P. (2020). Neuroanatomy, autonomic nervous system visceral afferent fibers and pain. In: StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560843/.
Shayota B., Wong T.L., Fru D., David G., Iwanaga J., Loukas M., Tubbs R. S. (2019). A comprehensive review of the sinuvertebral nerve with clinical applications. Anatomy & Cell Biology, 52(2), 128-133. doi:10.5115/acb.2019.52.2.128 – DOI – PMC – PubMed
Sigalos J. T., Pastuszak A.W. (2017). Chronic orchialgia: Epidemiology, diagnosis and evaluation. Translational Androloy and Urology, 6(Suppl 1), S37-S43. doi:10.21037/tau.2017.05.23 – DOI – PMC – PubMed
Sikandar S., Sommer C. (2019). Neurotrophins, cytokines, and pain. In: Wood J. N., (ed.), The Oxford Handbook of the Neurobiology of Pain. Oxford University Press. doi:10.1093/oxfordhb/9780190860509.013.25 – DOI
Smith K. M., Browne T. J., Davis O. C., Coyle A., Boyle K. A., Watanabe M., Graham B. A. (2019). Calretinin positive neuron from an excitatory amplifier network in the spinal cord dorsal horn. eLife, 8, e49190. doi:10.7554/eLife.49190. – DOI – PMC – PubMed
Smith R. P., Costabile R. A. (2017). Chronic orchialgia. Translational Androloy and Urology, 6(Suppl 1), S1. doi:10.21037/tau.2017.05.01 – DOI – PMC – PubMed
Sørensen I. G., Jacobsen P., Gyntelberg F., Suadicani P. (2011). Occupational and other predictors of herniated lumbar disc disease- A 33-year follow-up in the Copenhagen male study. Spine, 36(19), 1541–1546. doi:10.1097/BRS.0b013e3181f9b8d4 – DOI – PubMed