Injections and needles to treat coccyx pain

See also personal experiences of injections

Injection of local anesthetic

Injection of anesthetic is a standard method for diagnosis of coccydynia - if an injection of a local anesthetic into the tissues around the coccyx eliminates the pain for a few hours, then the coccyx is the source of the pain. See Coccydynia/Levator Syndrome, A Therapeutic Test.

Injection of anesthetic can also be used to reduce the pain in the long term. Dr Clemens Franzmayr, author of Therapies successful on pain in coccygeal area, says: 'I don't inject corticosteroids, but I use a local anesthetic (Lignocaine 1%), and carry this out repeatedly up to five times. It has been proven worldwide that injections of local anesthetic to trigger points, or dry needling, have the same results as cortisone injections, but have practically no side effects.'

Dr Patrick Foye, director of the Coccyx Pain Service, UMDNJ: New Jersey Medical School, (see Doctors and specialists in the USA, New Jersey) uses repeated injections of local anesthetic into the ganglion impar, a cluster of nerve cells in front of the joint between the sacrum and the coccyx. He finds that after the initial anesthesia wears off, the pain level is often lower than before the injection. Successsive injections can reduce the pain further. See Injection of the ganglion impar, Coccydynia Successfully Treated with Ganglion Impar Blocks: A Case Series, CT-guided injection for ganglion impar blockade.

Injection of corticosteroid

Corticosteriod (cortisone or a related drug) is a long-acting anti-inflammatory. The treatment is similar to that given to treat tennis elbow. In most patients with tailbone pain an injection of corticosteriod can reduce or eliminate the pain for a period of a month to a year, but not permanently for most patients. Repeated injections of corticosteriod can cause thinning of the tissue, so most doctors will not give more than two or three of these injections.

Among orthopedic doctors, injection of corticosteriod is the standard first treatment once it has been established that the coccyx is the source of the pain. Most people find that the injection makes the pain worse for a week or so, and it may take up to two weeks for a real benefit to be felt.

If these injections do give some relief, even if it is partial and temporary, it is regarded as a good sign that surgery is likely to be effective.

There are three versions of this treatment that I have come across. The first is the simplest, and may be carried out in the doctor's surgery, but it is less effective than the other two versions.

  1. Injection around the coccyx. In the trial reported in Coccydynia. Aetiology and treatment, the authors say that they inject into the tissues around the coccyx, but not into the joint between the coccyx and the sacrum. At first the corticosteroid acts as an irritant, and you are likely to feel worse for some days before you feel better. The relief from coccydynia is not immediate, but may happen over days or weeks. The paper reports initial success in 60% of patients and long-term success in 45%.
  2. Injection around the coccyx with manipulation. In this version, the doctor first injects the corticosteroid and local anesthetic, then he or she manipulates the coccyx for around a minute. This treatment is done under a light general anesthetic to prevent you feeling the pain and to allow the doctor to do a more thorough job. The paper above reports initial success in 85% of patients and long-term success in 60%.
  3. Injection into the joint. Dr Jean-Yves Maigne, author of Treatment strategies for coccydynia, injects directly into the affected joint itself, rather than the tissues around the coccyx. He says: 'For me, the first treatment is an anti-inflammatory injection (steroid) in the affected joint, as identified by the dynamic films [sit/stand x-rays]. This can only be done under fluoroscopic [x-ray] control. The result occurs within one week and provides a two to four month relief in 60 to 70% of the patients and full recovery (at one year) in 30%. Despite there is a theoretical risk of local infection, I have performed more than 500 injections in 8 years without any problem. In 10% of the cases, there is a marked post-injection pain for a couple of days.'

Prolotherapy (injection of irritant solution)

A ligament repair treatment called prolotherapy or sclerotherapy has been used for coccydynia. It involves injecting an irritant solution (which may just be a glucose solution) into the ligaments and the ligament/bone interface, and it is claimed that the inflammation that this causes results in shorter and stronger ligaments. On the face of it, this would seem to be particularly suitable for cases of coccydynia caused by damaged ligaments. But this method is generally frowned on by the medical establishment, who say that it is not a proven method.

30 people who have had this treatment have contacted me, with the following results:

A paper by Polsdorfer gives an account of the successful treatment by prolotherapy of two people whose coccyx pain was not cured by other treatments. A more detailed trial of prolotherapy using dextrose by Khan et al found that 30 out of 37 patients received good pain relief using this method, the other 7 being no worse than when they started. Note that the patients selected for the trial did not include any whose coccyx pain was the result of trauma or subluxation (dislocation) of the coccyx. Dr Khan has told me that he has found that prolotherapy was less successful in cases of coccyx pain caused by trauma.

The doctors who advocate this treatment say that it is important that it is carried out by someone who is properly trained. So if you do decide to go for this, make sure you ask the doctor what training he or she has had, how may people he or she has treated with prolotherapy and how successful it was. Also note that one patient pointed out that the purpose of the treatment is to create irritation, so it is important to avoid painkillers that reduce inflammation while undergoing prolotherapy. If you have had this treatment, please let me know what the outcome was.

Dry needling (insertion of a needle without injecting)

Acupuncture

Acupuncture is based on traditional Chinese practice. Needles are inserted into the body at specific points, not generally the places where the pain is. While they are in place the needles may be rotated or connected to a low current electrical supply. It has been suggested that acupuncture may stimulate the body's production of endorphins (natural pain-killers), or that one stimulation of the nervous system can block signals in another pathway. Most people who have written to me who have tried this have found that any relief of pain is only partial and temporary.

Intramuscular stimulation (IMS)

This is a treatment for chronic pain involves the insertion of thin acupuncture type needles into muscles at the site of the pain, which the practitioners say are supersensitive and shortened. At first this is uncomfortable, then the muscle relaxes. The treatment is used for various types of pain including back pain and the pain caused by loss of an arm or leg. An average of 8 treatments are given at weekly intervals. The doctors, osteopaths, etc who give this treatment report that it is often effective with long-standing pain. No trials of the treatment for any type of pain have been published in a medical journal, so far as I can discover, but a trial has been published on the internet, Dry-Needling of Muscle Motor Points for Chronic Low-Back Pain. A clinical trial has started at Addenbrookes Hospital, Cambridge, UK. More details on IMS at the Intramuscular Stimulation site.

Mesotherapy

Mesotherapy is treatment used for various conditions including pain invented in France, involving many small injections. The injections are made just under the skin with short needles or an electronic injector. Injections of small amounts of various substances are made local to the site of the pain. There are many practitioners in France - see Geraldine's story (in French). A practitioner in Portugal has been recommended by a Fausto. In the USA, mesotherapy has been adopted mainly as a cosmetic treatment, supposedly destroying fat cells.

Updated 2013-10-20

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