Testicle pain from undiagnosed chronic musculoskeletal problems

Testicular pain that lingers without relief, despite numerous treatment attempts, is considered a chronic condition. Often, chronic testicular pain is labeled as “testicular pain of unknown origin” and the only treatment option available becomes pain management.

This may involve the use of anti-inflammatorynarcotic medicationscortisone injections into the spine or pubis.

While these treatment modalities may help to ease pain temporarily, they do not stimulate the healing of soft tissues or address the underlying condition. The question becomes: what is the underlying condition of “testicular pain of unknown origin?” Frequently, the underlying issue is actually related to ligament laxity. Ligament tissues that are “loose” or injured can cause chronic pain. These may be spinal ligaments.

Is testicular pain coming from spinal problems?

Ligament Pain Referral PatternssReferral pain, meaning problems in the spine that effects the nerves of the genitals is not a new idea. It is however getting more attention because of the number of failed procedures surrounding both back pain and testicular pain.

Back in 2003 researchers at the University of Southern California noted that “Unsuccessful recognition of the origin of testicular pain and a high failure rate of surgical interventions lead to poor outcomes, psychologic distress, and increased costs of care.

A frequently overlooked cause of testicular and buttock pain is irritation of the T10-L1 sensory nerve roots, the genitofemoral nerve, and the ilioinguinal nerve.”1 This is a pain or problem of the mid-back (thoracic spine) that runs through the nerves of the groin with subsequent testicular pain.

In one case history doctors at Bridgewater State University reported on a case of an athletic 49-year-old male who suffered from chronic non-traumatic testicular pain. The cause of his problems was undiagnosed Sacroiliac Joint Dysfunction which caused pressure on the pudendal nerve that runs through the pelvis and effects the genitals.2

Problems of back pain are increasingly being seen as a “surprising” cause of testicle pain. In new research doctors found that in a few patients spinal cord stimulation (electrical nerve stimulation).3 Please see this article for the limitations of Spinal Cord StimulatorsAlso see problems of the groin

Prolotherapy can stimulate healing of  unresolved testicular pain by repairing injured ligaments that may be referring pain to the testicles or groin. It works by initiating a mild inflammatory response in the treated area (i.e. the iliolumbar ligament), which attracts immune cells to heal the structure(s) in that area. With time and multiple treatments, patients usually notice a gradual decrease in testicular pain as injured tissues continue to heal. In more severe cases, the entire pelvic floor is involved and needs treatment (including the pubis, ischial tuberosities, and coccyx). Once the weak tissues have been identified and treated with Prolotherapy, chronic testicular pain usually subsides.

1 Doubleday KL, Kulig K, Landel R. Treatment of testicular pain using conservative management of the thoracolumbar spine: a case report. Arch Phys Med Rehabil. 2003 Dec;84(12):1903-5.

2 Leone JE, Middleton S. Nontraumatic Testicular Pain due to Sacroiliac-Joint Dysfunction: A Case Report. J Athl Train. 2016 Aug;51(8):651-657. Epub 2016 Sep 14.

3. Kiritsy MP, Siefferman JW. Spinal Cord Stimulation for Intractable Testicular Pain: Case Report and Review of the Literature. Neuromodulation. 2016 Aug 15. doi: 10.1111/ner.12487.

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