Interdisciplinary pain management is beneficial for refractory orchialgia in children

• Published in: Journal of pediatric urology 2015-06, Vol.11 (3), p.123.e1-123.e6
• Main Authors: Ching, C.B, Hays, S.R, Luckett, T.R, Mason, M.D, Clayton, D.B, Tanaka, S.T, Thomas, J.C, Adams, M.C, Brock, J.W, Pope, J.C
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Chronic Disease; Humans; Interdisciplinary; Male; Nerve block; Orchialgia; Pain Management; Pain, Intractable - complications; Pain, Intractable - diagnosis; Pain, Intractable - therapy; Pediatrics; Retrospective Studies; Testicular Diseases - complications; Testicular Diseases - diagnosis; Testicular Diseases - therapy; Treatment Outcome; Urology
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2014.12.005

Summary Introduction Idiopathic testicular/groin pain can be a difficult entity for children, their families, and caregivers. The role of interdisciplinary pain management has previously been demonstrated in treating chronic orchialgia at the present pediatric pain clinic. Objective To evaluate the role of interdisciplinary pain management in managing refractory orchialgia. It was hypothesized that children with refractory orchialgia might respond well. Interdisciplinary care was defined as that which crosses two medical disciplines such as a surgical specialty and specialist in analgesia. Subjects and methods Pediatric patients were identified who were: ≥10 years old; evaluated in the pediatric urology clinic between 2002 and 2012; were diagnosed wtih ICD code 608.9 or had the diagnosis of male genital disorder NOS. Children were included if they presented with orchialgia without an identifiable cause and failed conservative management (rest, scrotal support, Sitz bath, timed voiding, constipation avoidance) including conventional anti-nociceptive analgesics (acetaminophen, non-steroidal anti-inflammatory drugs, opioids). Patient electronic medical records were reviewed retrospectively. Results Twenty-two children met inclusion criteria. Mean age was 13.7 years (range 10–17). Nearly half (45%) of the children had chronic medical conditions such as asthma, allergies, and obesity. Twenty-one of the 22 children were referred to the pediatric pain clinic; 15 were evaluated, and one refused treatment. All children evaluated in the pediatric pain clinic were initially offered an empiric anti-neuropathic anti-convulsant (i.e. gabapentin) and/or an anti-depressant (i.e. amitriptyline) before being offered a nerve block. Of the 14 children accepting treatment in the pediatric pain clinic, six were treated solely with an empiric anti-neuropathic anti-convulsant and/or anti-depressant; eight received medications followed by nerve block (seven ilioinguinal–iliohypogastric blocks, one spinal and ilioinguinal–iliohypogastric block) (see Fig. 1). A total of eight of the 14 children (57%) treated by the pain clinic had resolution of pain, with 50% of those treated with medications alone (three out of six children) responding (two responding to gabapentin and a tricyclic antidepressant, one to gabapentin alone); and five out of eight (63%) treated with medications and then nerve block (ilioinguinal–iliohypogastric block) responding. Of the eight children undergoing nerve