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A Review of Current Treatment Options for Coccygodynia

Abstract

Purpose of Review

Coccygodynia is pain within the coccyx area. The diagnosis is made clinically with symptoms of pain in the coccyx region and worsening pain in sitting position. The initial treatment is conservative therapy. For patients who do not respond to conservative therapies, there are further interventions available. This includes local injection of local anesthetics and steroids, neurolysis of sacral nerve roots, caudal epidural block, pulse radiofrequency (PRF), intra-rectal massage and manipulation, ganglion impar block, levator ani massage and stretching, coccyx manipulation, and coccygectomy. The purpose of this review is to evaluate the efficacies of these interventions in the treatment of coccygodynia.

Recent Findings

Literature search was performed with the keywords including coccygodynia, treatment, and coccygectomy, on PubMed and Google Scholar between August 2012 and August 2017. Thirteen studies with patients age 18 and over who underwent treatments for coccygodynia were selected for analysis. These treatments include conservative therapies (physical therapy and capsaicin patch), interventional techniques (local injections with steroids and local anesthetic, pulsed radiofrequency ablation of ganglion impar, extracorporeal shock wave therapy), and surgical techniques (complete and partial coccygectomies). The results from these studies demonstrated that most patients had significant pain relief with these techniques.

Summary

Our literature review demonstrated various interventions including coccygectomy can be effective in the treatment of coccygodynia refractory to conservative therapies. There is a growing body of clinical evidence to support that coccygectomy is an effective treatment for patients with debilitating pain who had failed interventional therapies. Further randomized control studies should be conducted to examine duration of pain relief after coccygectomy and associated surgical complications.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

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Correspondence to Andrew Ng.

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Conflict of Interest

Yasmin Elkhashab and Andrew Ng declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Anesthetic Techniques in Pain Management

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Elkhashab, Y., Ng, A. A Review of Current Treatment Options for Coccygodynia. Curr Pain Headache Rep 22, 28 (2018). https://doi.org/10.1007/s11916-018-0683-7

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  • DOI: https://doi.org/10.1007/s11916-018-0683-7

Keywords

  • Coccygodynia
  • Coccyx pain
  • Ganglion impar
  • Coccygodynia treatment
  • Coccygectomy
  • Ganglion impar block