I have had two patients in the last couple of months that brought to mind the importance of the lower thoracic sympathetic ganglia. These ganglia are difficult to reach with the neural therapist's needle, but important for a variety of reasons.
Both were men in their late sixties. One presented with recurring testicular pain following direct trauma 17 years before, and the other with chronic pain in the groin following an inguinal hernia repair two years previously. The common denominator of their conditions was an interference field in a lower thoracic (approximately T10 to L1) sympathetic ganglion.
The man with the testicular pain had a history of recurring attacks. These episodes sometimes coincided with "flares" of inflammation of his haemorrhoids, strains of his back, or (on one occasion) a kidney infection. Sometimes interference fields were found in the testicle, but on more than one occasion interference fields were found in the ipsilateral T10 sympathetic ganglion. At times more than one treatment was required but he often would be free of pain for more than a year.
The course of the patient with post-hernia repair pain was more straightforward. On his first visit a T10 sympathetic ganglion interference field was found on autonomic response testing (none in the scar). His response to treatment was satisfactory but on recurrences the scar interference fields became apparent and needed to be treated twice before the pain disappeared for good.
Chronic pain in the groin or testicle (sometimes called orchialgia) is usually an enigma to urologists and other physicians with conventional medical training. Testicular pain has been receiving considerable research attention, but because 50% of cases have been considered to be idiopathic the usual suspicions of secondary gain, psychogenic factors, etc. come to the fore. Only one report (from 1994) recognized the spinal region to be an important source of testicular pain, although disappointingly "radiculitis" was the only explanation on offer.
With such poor understanding of the nature of the pain, it is not surprising that orchiectomy is sometimes offered (with variable results). The latest surgical fashion is now micro denervation of the spermatic cord. How sad to see testicular pain joining that long list of conditions for which surgery has been offered, and all for lack of understanding of how the pain occurs!
Occult testicular or groin pain is definitely the realm of the neural therapist! There should be no "idiopathic" pain when the principles of neural therapy are applied. The keys are, as always, to look for sources of irritation of the nervous system: scars, history of epididymitis or other scrotal infection, trauma, and musculoskeletal disturbance. If no obvious interference fields can be found by history, Dosch recommends a series of test injections of dilute procaine: quaddles into dermatomes T10 to L3 and S2, direct injections into the spermatic cord or testicle, pudendal nerve blocks, and epidural or presacral infiltration (p. 243 of Dosch's Manual of neural therapy according to Huneke ‐ 2nd edition).
Personally, I have found that if no interference field is apparent, and even when there is one, but it does not respond well, the key is an interference field in a lower thoracic sympathetic ganglion. I suspect that these are not often searched for because the injection technique (page 186 of my book) is so intimidating. Sliding a three‐inch (7.5cm) needle under the lung with the patient in expiration is one of the more challenging injections in neural therapy. My guess is that most neural therapists resort to it only when all else fails.
I have done a number of them over the years, but each occasion did not fail to elicit a light sweat and relief (on my part) when it was over. Thankfully, most times it is a therapeutically rewarding procedure.
However, the lower thoracic sympathetic ganglia is an area where an energetic approach truly shines, both in diagnosis and treatment. Autonomic response testing (if positive) gives the assurance that an injection is worthwhile. And energetic treatment (I use the Tenscam device) is as effective as the injection, much faster, and with none of the risks. Previously, I would have to schedule a special appointment for the injection procedure. Now, I can include a treatment (which takes about a minute) into the appointment and can treat as soon as the interference field is found.
My experience is that energetic treatment is as effective as procaine injections, but I have to be careful when I say this. I really have not had enough feedback from other practitioners to be sure that this is true. It would be very helpful if those who do use energetic treatments (especially of autonomic ganglia) would share their experience with readers of this newsletter.
Robert F. Kidd, MD, CM