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Rahimibarghani S, Morgan R, Diaz JJ. Neuromodulation Techniques in Chronic Refractory Coccydynia: A Narrative Review. Pain Ther 2024; 13:53-67. [PMID: 38175492 PMCID: PMC10796902 DOI: 10.1007/s40122-023-00572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
Refractory coccydynia is a condition characterized by severe coccygeal pain and poses a challenging management dilemma for clinicians. Advancements in neuromodulation (NM) technology have provided benefits to people experiencing chronic pain that is resistant to standard treatments. This review aims to summarize the spectrum of current NM techniques employed in the treatment of refractory coccydynia along with their effectiveness. A review of studies in the scientific literature from 2012 to 2023 was conducted, revealing a limited number of case reports. Although the available evidence at this time suggests significant pain relief with the utilization of NM techniques, the limited scope and nature of the studies reviewed emphasize the need for large-scale, rigorous, high-level research in this domain in order to establish a comprehensive understanding of the role of NM and its effectiveness in the management of intractable coccydynia.
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Affiliation(s)
- Sarvenaz Rahimibarghani
- Physical Medicine and Rehabilitation Department, Tehran University of Medical Sciences, Tehran, Iran.
| | - Richard Morgan
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL, USA
| | - Jose Juan Diaz
- Physical Medicine and Rehabilitation Department, Larkin Community Hospital, South Miami Campus, South Miami, FL, USA
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Chang Chien G, Patel A, Wang D. Bipolar radiofrequency ablation of the anococcygeal nerve for the treatment of chronic coccydynia: A case report. INTERVENTIONAL PAIN MEDICINE 2022; 1:100115. [PMID: 39238516 PMCID: PMC11372932 DOI: 10.1016/j.inpm.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 09/07/2024]
Affiliation(s)
- George Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA
- GCC Institute for Regenerative Medicine, Irvine, CA, USA
| | - Ankur Patel
- New York Presbyterian Hospital - Columbia University Medical Center and Weill Cornell Medical Center, USA
| | - Daniel Wang
- Kansas City University, Kansas City, MO, USA
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Feigin G, Wang NN, Di Grazia V, Peng P. Novel approach for pericapsular radiofrequency ablation of sacrococcygeal junction for patients with coccydynia. Reg Anesth Pain Med 2022; 47:259-262. [DOI: 10.1136/rapm-2021-103183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022]
Abstract
IntroductionCoccydynia is a multifactorial complex clinical challenge. A multimodal approach with both conservative measures and procedural interventions is often recommended. We described a novel approach of radiofrequency (RF) ablation for the management of coccydynia.MethodsThree patients with known history of coccydynia refractory to conservative therapy were referred to our clinic. All received different types of RF ablation before: one with anterior bipolar lesion with no analgesia benefit, one with posterior stripped lesion with good benefit but only after 8 weeks of pain flare and one received anterior monopolar lesion with 50% pain reduction for 2–3 months. All subjects underwent a novel RF ablation to the anterior surface of the sacrococcygeal and intercoccygeal joints with two bipolar lesions using multi-tined needles under fluoroscopy guidance. One bipolar lesion was between two needles: one in the sacrococcygeal and another in the intercoccygeal (between first and second coccyx) joints. Another bipolar lesion was between needles on both side of the sacrococcygeal joint.ResultsAll experienced at least 65% pain relief for 6 months. The sitting endurance increased from less than 5 min to an average of 70 min. No adverse effect was observed in two and in the patient who used to have pain flare after lesioning, the pain flare lasted only for 2 weeks.DiscussionThe configuration of the two bipolar lesions with multi-tined needles in this case series stimulates the thinking of new approach for the ablation technique for pain from coccyx. Further prospective large case cohort study is needed.
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Lyon KA, Huang JH, Garrett D. Influence of psychiatric disorders and chronic pain on the surgical outcome in the patient with chronic coccydynia: a single institution's experience. Neurol Res 2020; 42:789-794. [PMID: 32496925 DOI: 10.1080/01616412.2020.1775014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Performing coccygectomy procedures on patients with psychiatric disorders and/or chronic low back pain have been previously thought of as contributing factors leading to inconsistent and often poor results. To determine if these two variables affect the post-operative pain relief obtained after coccygectomy, an analysis of the opioid requirements and pain descriptions before and after surgery was undertaken in each patient studied. METHODS The hospital electronic medical records were searched, and only patients undergoing coccygectomy for chronic coccydynia were selected. A total of 8 patients were found. Each patient underwent a trial of conservative therapy prior to surgical evaluation. RESULTS The average duration of symptoms prior to surgery was 41.3 months. In 7 out of 8 patients, at least one psychiatric disorder was present. In 6 out of 8 patients, chronic low back pain was present. Pain control with opioid-based medicines was required in 5 out of 8 patients prior to surgery. Of those, 4 were able to discontinue or reduce the amount of opioid-based medicines consumed after surgery. The average follow-up was 9 months. DISCUSSION The results of this study indicate that patients with preexisting psychiatric disorders and/or chronic low back pain suffering from debilitating coccyx pain can obtain pain relief after coccygectomy as seen from a reduction in opioid requirements and pain burden. It should be noted that the obtained benefits from coccygectomy usually occur in a delayed fashion.
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Affiliation(s)
- Kristopher A Lyon
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center , Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine , Temple, TX, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center , Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine , Temple, TX, USA
| | - David Garrett
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center , Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine , Temple, TX, USA
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Gönen Aydın C, Örsçelik A, Gök MC, Akman YE. The Efficacy of Extracorporeal Shock Wave Therapy for Chronic Coccydynia. Med Princ Pract 2020; 29:444-450. [PMID: 31918431 PMCID: PMC7511685 DOI: 10.1159/000505835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/09/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Coccydynia is a disorder that decreases quality of life with significant functional failure. Extra-corporeal shock wave therapy (ESWT) is used to treat several painful musculoskeletal disorders. SUBJECTS AND METHODS The medical records of 34 patients (29 females, 5 males) who had been treated with ESWT between 2017 and 2018 for chronic coccydynia were evaluated. Visual analog scale (VAS) scores were noted at the initial consultation, at each session, and during the initial and follow-up (at 6 months) examinations after the treatment. The 36-item short form (SF-36) quality of life scale survey was conducted at the beginning and end of the treatment. MRI was performed before the start of the procedure and 1 month after the end of the treatment. RESULTS The mean VAS score was 9.6 (9-10) before the treatment and 3.4 (0-2) after the treatment (p < 0.05). The VAS score decreased to ≤3 in 79.4% of patients. Bone marrow edema regressed in 6% of patients. Significant improvement was observed in all of the SF-36 parameters, except for two. CONCLUSION In our patient group, ESWT provided effective pain control. In order to evaluate the efficacy of ESWT more accurately and sensitively, prospective randomized studies with longer follow-up periods, in which ESWT is compared with different energy doses and different treatment methods, are needed.
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Affiliation(s)
- Canan Gönen Aydın
- Department of Sports Medicine, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey,
| | - Aydan Örsçelik
- Department of Sports Medicine, University of Health Sciences Gülhane Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Cantay Gök
- Department of Radiology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Yunus Emre Akman
- Private Practice in Orthopedics and Traumatology, Istanbul, Turkey
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Evidence Analysis of Sympathetic Blocks for Visceral Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00226-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chen Y, Huang-Lionnet JHY, Cohen SP. Radiofrequency Ablation in Coccydynia: A Case Series and Comprehensive, Evidence-Based Review. PAIN MEDICINE 2018; 18:1111-1130. [PMID: 28034983 DOI: 10.1093/pm/pnw268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objectives Coccydynia is a condition with a multitude of different causes, characterized by ill-defined management. There are multiple prospective studies, including several controlled trials, that have evaluated conservative therapies. Additionally, a plethora of observational studies have assessed coccygectomy, but few studies have reported results for nonsurgical interventional procedures. In this report, we describe the treatment results of 12 patients who received conventional or pulsed radiofrequency for coccydynia and systematically review the literature on management. Methods We performed a retrospective data analysis evaluating patients who underwent pulsed or conventional radiofrequency treatment at Johns Hopkins Hospital and Walter Reed National Military Medical Center. A comprehensive literature review was also performed to contextualize these results. Results The mean age of patients treated was 50.25 years (SD = 11.20 years, range = 32-72 years), with the mean duration of symptoms being 3.6 years (SD = 3.36 years, range 1-10 years). There were 10 males and two females in this cohort. Among patients who received radiofrequency treatment, the average benefit was 55.5% pain relief (SD = 30.33%, range = 0-100%). Those who underwent conventional (vs pulsed radiofrequency) and who received prognostic blocks were more likely to experience a positive outcome. There were two cases of neuritis, which resolved spontaneously after several weeks. Conclusions Radiofrequency ablation of the sacrococcygeal nerves may serve as a useful treatment option for patients with coccydynia who have failed more conservative measures. Further research into this therapeutic approach and its benefit for coccydynia should incorporate a control group for comparison.
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Affiliation(s)
- Yian Chen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Julie H Y Huang-Lionnet
- Department of Anesthesiology and Interventional Pain Medicine, Greenwich Anesthesiology Associates, Greenwich Hospital, Yale University, New Haven, Connecticut
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Neurology and Physical Medicine & Rehabilitation, Departments of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Youssef P, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS. Comprehensive anatomical and immunohistochemical review of the innervation of the human spine and joints with application to an improved understanding of back pain. Childs Nerv Syst 2016; 32:243-51. [PMID: 26280631 DOI: 10.1007/s00381-015-2880-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/07/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain of spinal origin contributes significantly to cervical, thoracic, and lower back pain presentations. Such pain originates in the nerve fibers supplying the joints or the surrounding ligaments and intervertebral discs. Although there has been little detailed discussion of spinal bony innervation patterns in the literature, the clinical implications of these patterns are anatomically and medically significant. METHODS The present review provides a detailed analysis of the innervation of the spine, identifying the unique features of each part via online search engines. CONCLUSIONS The clinical implications of these various studies lie in the importance of the innervation patterns for the mechanism of spinal pain. Immunohistochemical studies have provided further evidence regarding the nature of the innervation of the spine.
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Affiliation(s)
- Pamela Youssef
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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Woon JTK, Stringer MD. The anatomy of the sacrococcygeal cornual region and its clinical relevance. Anat Sci Int 2013; 89:207-14. [PMID: 24343170 DOI: 10.1007/s12565-013-0222-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/03/2013] [Indexed: 12/30/2022]
Abstract
There has been no systematic study of the anatomy of the region between the sacral and coccygeal cornua. Reference texts describe an intercornual ligament connecting these structures. The aim of this study was to investigate the anatomy of this region, which may be relevant to unexplained cases of coccygeal pain (coccydynia) and local nerve blocks. The bony anatomy of the sacrococcygeal (SC) cornual region was analyzed in 33 CT scans obtained from supine adults of mostly European origin with no known SC pathology, 7 μCT scans of cadaver SC specimens, and 105 Asian Indian adult skeletons. A further five cadaver SC specimens were examined histologically. SC cornual fusion was seen in 45% of CT/μCT scans (mean age 67 years, 20 males) and in 20% of adult skeletons (78 males); there was no association with age or sex. In the absence of SC fusion, the mean intersacrococcygeal cornual gap was 7.1 ± 2.4 mm; this was bridged by an intercornual ligament composed of parallel vertical collagen fibers reinforced by elastin fibers on its anterior surface. Small nerve branches were observed adjacent to the ventral aspect of the intercornual ligament and, in one case, traversing the ligament. Ipsilateral sacral and coccygeal cornua are therefore normally bridged by an intercornual ligament that is probably innervated. The cornua are fused on one or both sides in 20-45% of adults. These findings may have implications for some cases of coccydynia and for anesthetists performing local nerve blocks.
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Affiliation(s)
- Jason T K Woon
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin, New Zealand
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