Pediatric chronic orchialgia: patient population and patterns of care.
OBJECTIVE
A major hurdle in management of any chronic pain syndrome is understanding the population in which it occurs. We describe our pediatric population of patients with peripubertal and postpubertal chronic orchialgia.


METHODS
Pediatric patients ≥ 10 years of age seen between 2002 and 2012 were identified by ICD code 608.9, Male Genital Disorder NOS. Patients were included if they had orchialgia without identifiable cause lasting >3 months. Patient history, diagnostic evaluations, treatments, and outcomes were assessed.


RESULTS
Seventy-nine pediatric patients were identified. The mean age was 13.3 years (range 10-18); mean duration of orchialgia was 16.3 months (range 3-85). Thirty-three of 79 (42%) had concomitant medical conditions and/or psychiatric-behavioral issues. The mean follow-up was 7.1 months (range 0-70.4) with 41/79 (52%) having more than one office visit follow-up. Eleven patients were referred to a pediatric pain clinic; 10 out of 11 (91%) were evaluated there. Overall, 16 out of 41 (39%) had resolution of pain: nine out of 41 (22%) responding to conservative management vs seven of 10 (70%) responding to pain clinic management (3 to anti-neuropathic medications, 4 to nerve block).


CONCLUSIONS
Many pediatric patients with chronic orchialgia have co-morbidities amenable to multidisciplinary collaborative coordination of care. Referral to pediatric pain clinic can be of significant benefit.
Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Christina B
CB
Ching
Department of Anesthesiology, Vanderbilt University School of Medicine & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University School of Medicine & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Stephen R
SR
Hays
Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Samuel D
SD
Kaffenberger
Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Heidi A
HA
Stephany
Perioperative Services & Pediatric Pain Service, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Twila R
TR
Luckett
Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Douglass B
DB
Clayton
Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Stacy T
ST
Tanaka
Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
John C
JC
Thomas
Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Mark C
MC
Adams
Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
John W
JW
Brock
Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA. Electronic address: john.pope@vanderbilt.edu.
John C
JC
Pope
D000293:Adolescent; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D059350:Chronic Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003952:Diagnostic Imaging; D004636:Emergency Service, Hospital; D006119:Groin; D006801:Humans; D008297:Male; D009407:Nerve Block; D018710:Pain Clinics; D059408:Pain Management; D011627:Puberty; D012017:Referral and Consultation; D013733:Testicular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome
D000700:Analgesics
Chronic pain; Nerve block; Orchialgia; Pediatrics