Investigation of Clinical Characteristics of Men with Chronic Unexplained Orchialgia

Abstract

Chronic pain is a public health issue in the United States. Men with chronic unexplained orchialgia (CUO) are an understudied population, with significant knowledge gaps regarding to demographics, etiology, and reliable treatment. This dissertation begins to address these gaps in knowledge, within a framework that presents an organized conceptual view of this chronic pain condition. The dissertation research and interpretation of its results interpretation are guided by the Biopsychosocial Model. This dissertation explored the feasibility of a clinic dedicated to the evaluation and management of adult men with chronic genital pain, but focused on screening for men with CUO. A total of 228 men were screened over 12.5 months; 124 reported chronic genital pain. 104 men had chronic testicular pain that had an identifiable cause; varicocele was the most common diagnosis (n = 55). 20 men had true CUO. This dedicated chronic male genital pain clinic established treatable causes for 84% of men referred for alleged CUO. This represents cost saving for men and healthcare by avoiding unnecessary surgical procedures. The second aspect of this dissertation was a cross-sectional sample case series. All 20 men with CUO were consented; 70% (n = 14) of the men returned a survey packet consisting of 16 standardized psychometric instruments evaluating the multidimensional nature of chronic pain. Instruments were evaluated with a sample of n = 12 in most cases. Demographic characteristics in the sample diverged from what has been previously reported about education and income. The median pain score was 4.00 out of 10 in the sample, with a median pain duration of 38.69 months. Men in the sample did not report urinary symptoms, depression/anxiety, or catastrophizing; instruments did not suggest a specific pain mechanism. Results showed evidence for self-reported dyscognition, fatigue and little belief in their own ability to decrease their pain. None reported a history of sexual trauma. Men reported less interference from chronic pain comorbidities in this sample than anticipated, SF-12 results conflicted with the other survey instruments, showing more impairment. This resaerch is the first to use standardized instruments to evaluate men with CUO. Future research will include replication investigation with a larger sample.