Spinal Cord Stimulation for Testicular Pain

Abstract

We report a case of malignancy-related testicular pain successfully treated by placement of spinal cord stimulator electrodes. Effective analgesia was provided by epidural lead placement over the dorsal columns. The rationale for our technique was based on contemporary understanding of spinal cord stimulation mechanism in conjunction with analysis of our patient's anatomical lesion location. A 57-year-old man with a history of prostate carcinoma status post a radical retropubic prostatectomy presented to our clinic with a 2-year history of progressive burning and stabbing left scrotal and inguinal pain. Given his inability to tolerate opioid analgesics, he underwent ilioinguinal, iliohypogastric, and ganglion impar nerve blocks, which relieved his inguinal pain. His testicular pain nevertheless persisted, and he therefore underwent a successful dual-lead trial of spinal cord stimulation prompting a permanent implant. Patient's responses to the visual analog scale (VAS) were collected at 10 time points over the course of 2 years under two conditions: no stimulation and dual-lead stimulation. Our patient's VAS questionnaire responses indicate a sustained 80% decrease of pain at 6 weeks status post-permanent spinal cord stimulator implant with self-reported increase of function at work and complete weaning off oral analgesics. Testicular pain may be difficult to treat particularly in patients unable to tolerate opioid analgesics. In cases that have failed conservative therapy, a trial of spinal cord stimulation should be explored.