[46M] With chronic abdominal and testicular pain

Patient Description

A 46-year-old male has been experiencing severe, constant pain in the right abdomen and right testicle area for about seven years, worsening over the last two years. The pain is described as sharp, stabbing, burning, throbbing, and constant, exacerbated by thoughts or attempts of sexual activity, stress, or yelling. The patient had the right testicle removed, but the pain persists, with slight swelling in the remaining testicle. Despite ultrasounds and antibiotics, there is no relief. Nerve medication was ineffective, and the patient resorts to high doses of ibuprofen. There is difficulty urinating, requiring manual assistance. No fever, chills, blood in urine, weight loss, or appetite loss reported. Diagnosed with high blood pressure and high liver enzymes since age 18, the patient takes amlodipine, benazepril, and atorvastatin daily, along with ibuprofen and a baby aspirin. Experiences dizziness when standing but has no known drug allergies.

Arora's Assessment

What might be happening

Your symptoms suggest a complex issue that may involve multiple factors:

Chronic Pain Syndrome: Given the duration and severity of your pain, it might be part of a chronic pain syndrome. This can occur even after surgery, like testicle removal, due to nerve damage or other factors.
Nerve Pain (Neuropathy): The sharp, burning, and throbbing nature of your pain could indicate nerve involvement. This might explain why typical pain medications haven't been effective.
Pelvic Floor Dysfunction: Difficulty urinating and pain during sexual activity might be related to pelvic floor issues, which can cause referred pain to the abdomen and testicle area.
Medication Side Effects: High doses of ibuprofen and other medications can contribute to gastrointestinal issues and may not effectively manage nerve-related pain.

What you can do

Pain Management:

Consult a Pain Specialist: Seek a pain management specialist who can explore alternative treatments like nerve blocks, physical therapy, or non-opioid medications.
Consider Non-Medication Therapies: Techniques like cognitive behavioral therapy, acupuncture, or biofeedback might offer some relief.

Lifestyle Adjustments:

Diet and Hydration: Ensure a balanced diet and adequate hydration to help manage constipation and overall health.
Gentle Exercise: Engage in gentle exercises, like walking or stretching, to improve circulation and reduce stress.

Medication Review:

Discuss with Your Doctor: Review your current medications with your healthcare provider to address side effects like dizziness and explore alternatives.

Symptom Tracking:

Use MDandMe: Journal your symptoms, track progress, and share insights with your healthcare provider to help guide treatment decisions.

What you should look out for

Seek Immediate Care: If you experience new symptoms like fever, severe swelling, or changes in urination, seek medical attention promptly.
Monitor for Side Effects: Be aware of any new side effects from medications and report them to your doctor.

Remember, it's important to work closely with healthcare professionals to find a treatment plan that works for you.

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3 mo ago

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