Rapid Pain Reduction Following a Multimodal Physiotherapy Protocol in a Retrospective Case Series of Patients With Persistent Scrotal Content Pain.

introductionScrotal content pain (SCP) is a clinically significant condition that can substantially impair quality of life. The causes of SCP are heterogeneous and may include urologic, neuropathic, musculoskeletal, vascular, inflammatory, referred, and psychosocial contributors. In some patients, dysfunction of the lower abdominal wall, inguinal canal, or pelvic floor may contribute to regional nerve irritation and persistent pain. The objective of this retrospective case series was to describe pain and quality-of-life outcomes following a multimodal physiotherapy protocol in men with persistent SCP.

methodsTwenty-eight men with persistent SCP, with a mean age of 42.1 years (95% CI, 36.3 to 47.9), who completed the four-week protocol and had complete baseline and post-treatment outcome data were included. The protocol consisted of four weekly sessions of class IV laser therapy, dry needling, pulsed electromagnetic field therapy, manual therapy, progressive therapeutic exercise, and daily oral tadalafil. Pain was measured before and after each session using a 10-cm visual analog scale (VAS). Physical and mental health were assessed before treatment and after the final session using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10. Available follow-up data were reviewed for symptom recurrence and additional treatment.

resultsMean VAS pain decreased from 8.0 cm (95% CI, 7.8 to 8.2) before the first treatment session to 3.0 cm (95% CI, 2.6 to 3.4) immediately after the first session and to 0.8 cm (95% CI, 0.4 to 1.1) after the fourth session. PROMIS Global-10 Physical Health scores increased from 40.6 to 51.7, and Mental Health scores increased from 46.7 to 51.1. At three to six months, 25 patients were contacted, and none reported pain recurrence requiring additional treatment. At six to 12 months, 22 patients were contacted, of whom four reported recurrence that interfered with activities of daily living (ADL) and underwent additional treatment.

conclusionsIn this retrospective case series, completion of a four-week multimodal protocol was associated with substantial short-term reductions in self-reported pain and improvements in global physical and mental health in men with persistent SCP. Because the study lacked a control group, included multiple concurrent interventions, and had incomplete long-term follow-up, causality, component-specific effects, and treatment durability cannot be established. Prospective controlled studies are warranted.