CASE REPORT article
Front. Med.
Sec. Precision Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1650218
This article is part of the Research TopicMixed Pain: A challenging diseaseView all articles
Mixed Chronic Scrotal Pain Secondary to Piriformis Scarring Treated with PRF: A Case Report
Provisionally accepted
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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In the complex pathological context of mixed pain, where nociceptive, neuropathic, and nociplastic mechanisms coexist and interact, we present an innovative diagnostic-therapeutic model for refractory chronic scrotal pain (CSP) in a 49-year-old male. The pain originated from pudendal nerve entrapment secondary to piriformis scarring. Comprehensive evaluation revealed mixed pain mechanisms: neuropathic (lancinating pain, S2-S4 dermatomal hypoesthesia, MRI-confirmed nerve compression), nociceptive (MRI-documented proven inflammation, mechanical stress exacerbation), and nociplastic (central sensitization with prolonged pain duration and psychological comorbidities).To address the stratified intervention needs of mixed pain, we implemented a mechanism-targeted strategy-ultrasound-guided pulsed radiofrequency (PRF, 42℃/240s) at the inferior piriformis margin to neuromodulate compressed nerves, perineural ozone/steroid injections modulated the immunoinflammatory microenvironment, and citalopram managed central sensitization-with complete pain resolution (VAS 8→0) sustained at 3-month follow-up. This case uniquely demonstrates how post-surgical piriformis scarring drives tripartite pain pathogenesis via neuroimmune-myofascial interactions: mechanical nerve compression, local inflammation, and subsequent central sensitization. The therapeutic strategy synergistically addressed all three cascades of mechanisms via C-fiber modulation, reduction of pro-inflammatory cytokines, and reversal of neuroplasticity. This report advances the understanding of CSP etiology beyond idiopathic causes, providing a reproducible mechanism-based precision model for mixed pain syndromes and advocating multidisciplinary management integrating interventional techniques, pharmacotherapy and psychorehabilitation.
Keywords: Mixed pain, Chronic scrotal pain, Chronic pelvic pain syndrome, piriformis muscle scar, Pulsed radiofrequency, Nerve entrapment
Received: 19 Jun 2025; Accepted: 05 Aug 2025.
Copyright: © 2025 Ding, Fan, Ji and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Feng Ji, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
Hua Xu, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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