Patrick Foye, M.D.

Patrick Foye

Founder and Director of the Coccyx Pain Center (Tailbone Pain Center), www.TailboneDoctor.com

Professor at Rutgers New Jersey Medical School, United States,

Author of the book: Tailbone Pain Relief Now

Contact details for Dr Foye are on the List of doctors and specialists in the USA (New Jersey).

See a list of Dr Foye's publications on coccyx pain

Summary of Evaluation and Treatment of Coccyx Pain

DIAGNOSIS: It is important to get an accurate diagnosis for what is causing your tailbone pain.

When patients travel in to see me at our Tailbone Pain Center, we typically do a thorough assessment to figure out what is causing their pain, and then we review treatment options.

TREATMENT: Dr. Foye's general considerations when treating tailbone pain

  1. Overview: As noted above, a crucial first step prior to treatment is to search for a specific cause for the patient's pain. Next, treatment of tailbone pain typically follows a stepwise progression, starting with the most simple approaches first, as shown in order below.
  2. Avoid exacerbating factors: We brainstorm with the patient regarding which activities make coccyx pain worse in most coccydynia patients and in their case specifically. Consider alternatives: for example, in their exercise program instead of doing sit-ups to strengthen their core/abdominal muscles, they could instead perform plank exercises and thus avoid putting pressure on the coccyx.
  3. Cushions: Most patients prefer cushions that have a "wedge" cut-out at the back. The coccyx essentially hovers over the cut-out area, instead of making contact with the chair.
  4. Sit-stand workstations: This can be helpful so that the patient can alternate between sitting and standing during the workday while at their desk or computer, for example.
  5. Modalities: a limited number of patients may find benefit from local icing at the area, although this body region is relatively inconvenient and awkward for applying such modalities while the patient is out and about, at work and such.
  6. Medications by mouth: There is a limited role for short-term use of medications taken by mouth to relieve pain or decrease inflammation. The problem with medications by mouth is that they can cause substantial side effects throughout the body, such as causing medical complications at the stomach, intestines, liver, kidneys, etc. Another problem with medications by mouth is that the medication is diluted out across the entire body, so that unfortunately very little of the medication taken by mouth actually makes it to the coccyx site where the patient is having their problem.
  7. Pelvic floor physical therapy: In the published medical literature, manipulation of the coccyx has relatively mediocre results. Still, if there is substantial muscular pain and dysfunction throughout the pelvic floor, pelvic floor physical therapy can be extremely helpful for those components of a patient's pain syndrome.
  8. Consider local medical interventions at the coccyx itself: By the time patients travel to see me at our Tailbone Pain Center, most people have already tried the items listed above. So, we often then move on to placing medication locally at the painful site, which is done by a small local injection.
  9. Coccyx steroid injection:
  10. Ganglion Impar sympathetic nerve block:
  11. Nerve ablation injections:
  12. Nerve ablation means that the physician is intentionally destroying or deadening the involved nerve fibers, so that they can no longer carry the pain signals.
  13. Regenerative medicine injections:
  14. Coccygectomy
  15. Ongoing treatment after coccygectomy:

CLOSING SUMMARY, by Dr. Foye:

It is unfortunate that such a large majority of people suffering from tailbone pain face such substantial difficulties in obtaining helpful medical care. It is a shame that most physicians have little or no experience in evaluating or treating coccyx problems. So, patients unfortunately have substantial roadblocks in getting appropriate testing (especially obstacles in getting the sitting-versus-standing x-rays of the coccyx), which leads to a lack in any accurate or specific diagnoses being made. Next, patients face challenges getting treatments that help to relieve their pain. I have treated thousands of patients with tailbone pain over the past 20+ years. I understand that people with tailbone pain can find the condition to be exhausting and frustrating. My heart goes out to those of you suffering from this condition. Through my publications, YouTube videos, website, etc., I continue working to educate physicians and patients about coccydynia. But we have a long way to go to get the message out. I wish you well on your journey to find relief. While the summary above is not intended as medical advice, my hope is that it will provide a helpful outline for you to discuss with your in-person treating physician. Please also make use of the wealth of additional information available here on www.coccyx.org and on my website www.TailboneDoctor.com.

-- Patrick Foye, M.D.


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