Management of Chronic Coccydynia and Associated Pain Syndromes

Chronic coccydynia, defined by persistent coccygeal pain often exacerbated by sitting, presents a therapeutic challenge owing to its multifactorial origin and variable response to treatment. Initial management emphasises ergonomic adjustments, pressure‐relieving cushions, non‐steroidal anti‐inflammatory drugs and tailored physiotherapy focusing on pelvic floor stretching and mobilisation. Diagnostic imaging, including dynamic radiographs and advanced modalities, aids in identifying coccygeal hypermobility, degenerative changes or soft tissue abnormalities. For patients unresponsive to conservative measures, minimally invasive interventions—such as targeted nerve blocks, pulsed radiofrequency neuromodulation, epidural corticosteroid administration and orthobiologic injections—have gained prominence. Extracorporeal shock wave therapy has emerged as a non‐invasive option to facilitate tissue repair and pain relief. In refractory cases, coccygectomy yields high rates of long‐term relief, provided patient selection is guided by thorough clinical and radiological assessment. Multidisciplinary collaboration remains pivotal to optimise outcomes and minimise procedural risks.

Research from Nature Portfolio

Recent three‐dimensional imaging work has established normative data on coccygeal morphology in standing versus supine postures, revealing that the coccyx becomes straighter and longer, with the tip migrating posteriorly and inferiorly under load. The sacrococcygeal angle increases markedly in the upright position, while lumbosacral alignment adjusts reciprocally. A moderate correlation between coccygeal tip migration and body mass index suggests biomechanical influences on pain generation. These findings offer a reference framework for interpreting positional abnormalities in patients with chronic pain and support the diagnostic value of weight-bearing computed tomography in assessing coccygeal kinematics.

Management of Chronic Coccydynia and Associated Pain Syndromes publication trend

The graph below shows the total number of articles in management of chronic coccydynia and associated pain syndromes across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic coccydynia: Persistent pain localised to the coccygeal region for more than three months, often aggravated by sitting or transitioning from sitting to standing.

Extracorporeal shock wave therapy (ESWT): Non-invasive delivery of acoustic pressure waves to injured tissues to stimulate neovascularisation, reduce inflammation and modulate nociceptive pathways.

Pulsed radiofrequency (PRF): Neuromodulatory technique that applies intermittent high-frequency electrical pulses to neural structures, achieving pain relief without thermal destruction of nerve fibres.

Ganglion impar block: Image-guided injection of local anaesthetic or neurolytic agent anterior to the coccyx to interrupt sympathetic and nociceptive signalling from the perineal and coccygeal regions.

Caudal epidural steroid injection (CESI): Administration of corticosteroid and local anaesthetic into the epidural space via the sacral hiatus to attenuate inflammation and alleviate radicular or axial coccygeal pain.

References

1. Evaluation of the effectiveness of caudal epidural steroid injection as an adjuvant to ganglion impar pulsed radiofrequency therapy in chronic coccygodynia. Heliyon (2024).
2. Favourable outcomes of coccygectomy for refractory coccygodynia. Annals of The Royal College of Surgeons of England (2014).
3. Retrospective evaluation of pain in patients with coccydynia who underwent impar ganglion block. BMC Anesthesiology (2020).
4. Three-dimensional evaluation of the coccyx movement between supine and standing positions using conventional and upright computed tomography imaging. Scientific Reports (2021).
5. Radial extracorporeal shockwave therapy (rESWT) for coccydynia: a prospective study of 14 patients. Annals of Medicine and Surgery (2023).