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Daily D, Bridges J, Mo WB, Mo AZ, Massey PA, Zhang AS. Coccydynia: A Review of Anatomy, Causes, Diagnosis, and Treatment. JBJS Rev 2024; 12:01874474-202405000-00004. [PMID: 38709859 DOI: 10.2106/jbjs.rvw.24.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
» Coccydynia is a painful condition affecting many patients at the terminal caudal end of the spine.» An understanding of coccyx anatomy and variations of morphology is necessary for proper diagnosis. A multifactorial etiology for pain may be responsible for this clinical entity.» Several treatment options exist. Successful outcomes for patients depend on individual patient characteristics and the etiology of pain.
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Affiliation(s)
- Drayton Daily
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - James Bridges
- School of Medicine, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - William B Mo
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Andrew Z Mo
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Patrick Allan Massey
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - Andrew S Zhang
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
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2
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Nourani B, Norton D, Kuchera W, Rabago D. Transrectal osteopathic manipulation treatment for chronic coccydynia: feasibility, acceptability and patient-oriented outcomes in a quality improvement project. J Osteopath Med 2024; 124:77-83. [PMID: 37999720 DOI: 10.1515/jom-2023-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
CONTEXT Pain of the coccyx, coccydynia, is a common condition with a substantial impact on the quality of life. Although most cases resolve with conservative care, 10 % become chronic and are more debilitating. Treatment for chronic coccydynia is limited; surgery is not definitive. Osteopathic manipulative treatment (OMT) is the application of manually guided forces to areas of somatic dysfunction to improve physiologic function and support homeostasis including for coccydynia, but its use as a transrectal procedure for coccydynia in a primary care clinic setting is not well documented. OBJECTIVES We aimed to conduct a quality improvement (QI) study to explore the feasibility, acceptability, and clinical effects of transrectal OMT for chronic coccydynia in a primary care setting. METHODS This QI project prospectively treated and assessed 16 patients with chronic coccydynia in a primary care outpatient clinic. The intervention was transrectal OMT as typically practiced in our clinic, and included myofascial release and balanced ligamentous tension in combination with active patient movement of the head and neck. The outcome measures included: acceptance, as assessed by the response rate (yes/no) to utilize OMT for coccydynia; acceptability, as assessed by satisfaction with treatment; and coccygeal pain, as assessed by self-report on a 0-10 numerical rating scale (NRS) for coccydynia while lying down, seated, standing, and walking. RESULTS Sixteen consecutive patients with coccydynia were offered and accepted OMT; six patients also received other procedural care. Ten patients (two males, eight females) received only OMT intervention for their coccydynia and were included in the per-protocol analysis. Posttreatment scores immediately after one procedure (acute model) and in follow-up were significantly improved compared with pretreatment scores. Follow-up pain scores provided by five of the 10 patients demonstrated significant improvement. The study supports transrectal OMT as a feasible and acceptable treatment option for coccydynia. Patients were satisfied with the procedure and reported improvement. There were no side effects or adverse events. CONCLUSIONS These data suggest that the use of transrectal OMT for chronic coccydynia is feasible and acceptable; self-reported improvement suggests utility in this clinic setting. Further evaluation in controlled studies is warranted.
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Affiliation(s)
- Bobby Nourani
- Associate Professor, Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine (NMM/OMM), College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Derek Norton
- Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, WI, USA
| | | | - David Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
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Temel MH, Bağcıer F. Letter to the Editor: The Influence of Gluteus Maximus Trigger Points and Dry Needling Technique on Coccydynia. Med Acupunct 2023; 35:348-349. [PMID: 38162545 PMCID: PMC10753945 DOI: 10.1089/acu.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Mustafa Hüseyin Temel
- Clinic of Physical Medicine and Rehabilitation, Üsküdar State Hospital, İstanbul, Turkey
| | - Fatih Bağcıer
- Clinic of Physical Medicine and Rehabilitation, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
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Shams A, Gamal O, Mesregah MK. Sacrococcygeal Morphologic and Morphometric Risk Factors for Idiopathic Coccydynia: A Magnetic Resonance Imaging Study. Global Spine J 2023; 13:140-148. [PMID: 33567908 PMCID: PMC9837515 DOI: 10.1177/2192568221993791] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES To evaluate the sacrococcygeal morphologic and morphometric features in idiopathic coccydynia using magnetic resonance imaging (MRI). METHODS MRI scans from 60 patients with idiopathic coccydynia were compared with scans of 60 controls. Assessment of coccygeal morphology included coccygeal segmentation, coccygeal types, bony spicules, sacrococcygeal joint fusion, and intercoccygeal joint fusion and subluxation. Morphometric parameters included coccygeal straight and curved lengths, coccygeal curvature index, sacrococcygeal and intercoccygeal joint angles, sacral straight and curved lengths, sacral curvature index, sacral angle, sacrococcygeal straight and curved lengths, sacrococcygeal curvature index, and sacrococcygeal angle. RESULTS The coccydynia group included 28 males and 32 females, with a mean age of 36.1 years. Type II coccyx and bony spicules were more common in coccydynia, P = 0.003 and 0.01, respectively. Sacrococcygeal joints were fused less commonly in coccydynia, P = 0.02. Intercoccygeal joint subluxation was more common in coccydynia, P = 0.007. The sacral angle was lower in coccydynia, P = 0.01. The sacrococcygeal curved length was higher in coccydynia, P < 0.001. The sacrococcygeal curvature index was lower coccydynia, P < 0.001. In females only, the coccygeal curvature index was lower in coccydynia patients, P = 0.04. In males only, the intercoccygeal angle was lower in coccydynia patients, P = 0.02. CONCLUSIONS Type II coccyx, bony spicules, intercoccygeal joint subluxation were more common, and sacrococcygeal joint fusion was less common in coccydynia patients. Sacral angle and sacrococcygeal curvature index were lower, while sacrococcygeal curved length was higher in coccydynia patients. LEVEL OF EVIDENCE Level 3. Case-control study.
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Affiliation(s)
- Ahmed Shams
- Department of Orthopaedic Surgery,
Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Osama Gamal
- Department of Orthopaedic Surgery,
Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery,
Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt,Department of Orthopaedic Surgery, Keck
School of Medicine, University of Southern California, Los Angeles, CA, USA,Mohamed Kamal Mesregah, Department of
Orthopaedic Surgery, Keck School of Medicine, University of Southern California,
Los Angeles, CA 90033, USA.
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Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy. J Pers Med 2022; 12:jpm12010101. [PMID: 35055416 PMCID: PMC8779548 DOI: 10.3390/jpm12010101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade.
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König MA, Grifka J, Benditz A. A novel radiological classification for displaced os coccyx: the Benditz-König classification. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:10-17. [PMID: 34495391 DOI: 10.1007/s00586-021-06971-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/01/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Treatment of coccygodynia is still a challenging entity. Clear surgical selection criteria are still lacking. The aim of the investigation was to establish a novel radiological classification for surgical decision-making in coccygodynia cases. MATERIAL AND METHODS Retrospective analysis of standing and sitting X-rays of coccygodynia patients referred to a single centre from 2018 to 2020. The sacro-coccygeal angle (SCA), the intra-coccygeal angle (ICA) and the difference of the intervertebral disc height (∆IDH) were measured. All coccyges were distributed in subtypes and correlated with the patients' treatment. RESULTS In total, 138 patients (female/male: 103/35) with a mean age of 45.6 ± 15.4 years were included in the study. In total, 49 patients underwent coccygectomy. Four different subtypes of displaced coccyges were identified: Type I with a non-segmented coccyx, anterior pivot, increased SCA and ICA from standing to sitting, ∆IDH = 1.0 ± 1.5 mm. Type II with a multisegmented coccyx, anterior pivot, increased SCA and ICA standing/sitting, ∆IDH = 1.1 ± 1.6 mm. Type III showed a posterior pivoted coccyx, negative SCA and ICA, ∆IDH = 0.6 ± 1.6 mm. Type IV is characterized by an anterior-posterior dissociation of the tail bone with a positive SCA, and the ICA shifted from a posterior to an anterior orientation. ∆IDH was - 0.6 ± 1.8 mm. CONCLUSION The presented radiological classification could help to facilitate the surgical decision-making for patients with displaced os coccyx. In addition, lateral and sitting X-rays were easy to perform and did not need unnecessary ionizing radiation like in CT scans and were more cost-effective than MRI investigations. The subtypes III and especially IV were more likely leading to surgery.
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Affiliation(s)
- Matthias A König
- Department of Orthopedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany.
| | - Joachim Grifka
- Department of Orthopedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
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White WD, Avery M, Jonely H, Mansfield JT, Sayal PK, Desai MJ. The interdisciplinary management of coccydynia: A narrative review. PM R 2021; 14:1143-1154. [PMID: 34333873 DOI: 10.1002/pmrj.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 11/07/2022]
Abstract
Pain that develops in the coccyx or surrounding tissues is known as coccydynia, which occurs as a result of many etiologies both traumatic and nontraumatic. Although coccydynia most commonly affects middle-aged women, it may be found in both sexes and in all age groups. The aim of this article is to provide an overview of the presentation, diagnostic imaging, and pathophysiology of coccydynia, and to comprehensively review the current treatment options. A review of publications from 1990 to 2020 using search words related to the treatment of coccydynia in PubMed and Google Scholar was completed. Level II evidence was found supporting stretching, manipulation, and extracorporeal shock wave therapy. There are no data from high-quality studies to support injection-based therapy including corticosteroids, prolotherapy, nerve blocks, and radiofrequency ablation, although there are small retrospective and prospective observational studies suggesting benefit. Level III evidence was found supporting coccygectomy for chronic/refractory coccydynia. There are no data from randomized controlled trials to support the use of neuromodulation (sacral burst and dorsal root ganglion stimulation), although there are case reports suggesting benefit. High-level, comparative studies are lacking to guide the treatment of coccydynia and should be a focus for future research studies.
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Affiliation(s)
- William D White
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar National Rehabilitation Hospital, Physical Medicine & Rehabilitation, Washington, District of Columbia, USA.,International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Melinda Avery
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Holly Jonely
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA.,The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - John T Mansfield
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar National Rehabilitation Hospital, Physical Medicine & Rehabilitation, Washington, District of Columbia, USA.,International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Puneet K Sayal
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA.,The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Castillo S, Joodi R, Williams LE, Pezeshk P, Chhabra A. Sacrum magnetic resonance imaging for low back and tail bone pain: A quality initiative to evaluate and improve imaging utility. World J Methodol 2021; 11:110-115. [PMID: 34322363 PMCID: PMC8299904 DOI: 10.5662/wjm.v11.i4.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/20/2020] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
As quality and cost effectiveness become essential in clinical practice, an evidence-based evaluation of the utility of imaging orders becomes an important consideration for radiology’s value in patient care. We report an institutional quality improvement project including a retrospective review of utility of sacrum magnetic resonance (MR) imaging for low back pain at our institution over a four-year period and follow-up results after physician education intervention. Sacral MR imaging for low back pain and tailbone pain were only positive for major findings in 2/98 (2%) cases, and no major changes in patient management related to imaging findings occurred over this period, resulting in almost $500000 cost without significant patient benefit. We distributed these results to the Family Medicine department and clinics that frequently placed this order. An approximately 83% drop in ordering rate occurred over the ensuing 3 mo follow-up period. Sacrum MR imaging for low back pain and tail bone pain has not been a cost-effective diagnostic tool at our institution. Physician education was a useful tool in reducing overutilization of this study, with a remarkable drop in such studies after sharing these findings with primary care physicians at the institution. In conclusion, sacrum MR imaging rarely elucidates the cause of low back/tail pain diagnosed in a primary care setting and is even less likely to result in major changes in management. The practice can be adopted in other institutions for the benefit of their patients and improve cost efficiency.
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Affiliation(s)
- Samantha Castillo
- Department of Radiology, UT Southwestern, Dallas, TX 75390, United States
| | - Robert Joodi
- Department of Radiology, UT Southwestern, Dallas, TX 75390, United States
| | | | - Parham Pezeshk
- Department of Radiology, UT Southwestern, Dallas, TX 75390, United States
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern, Dallas, TX 75390, United States
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9
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Skalski MR, Matcuk GR, Patel DB, Tomasian A, White EA, Gross JS. Imaging Coccygeal Trauma and Coccydynia. Radiographics 2021; 40:1090-1106. [PMID: 32609598 DOI: 10.1148/rg.2020190132] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The coccygeal region has complex anatomy, much of which may contribute to or be the cause of coccyx region pain (coccydynia). This anatomy is well depicted at imaging, and management is often dictated by what structures are involved. Coccydynia is a common condition that is known to be difficult to evaluate and treat. However, imaging can aid in determining potential causes of pain to help guide management. Commonly, coccydynia (coccygodynia) occurs after trauma and appears with normal imaging features at static neutral radiography, but dynamic imaging with standing and seated lateral radiography may reveal pathologic coccygeal motion that is predictive of pain. In addition, several findings seen at cross-sectional imaging in patients with coccydynia can point to a source of pain that may be subtle and easily overlooked. Radiology can also offer a role in management of coccygeal region pain with image-guided pain management procedures such as ganglion impar block. In addition to mechanical coccyx pain, a host of other conditions involving the sacrococcygeal region may cause coccydynia, which are well depicted at imaging. These include neoplasm, infection, crystal deposition, and cystic formations such as pilonidal cyst. The authors review a variety of coccydynia causes, their respective imaging features, and common management strategies.©RSNA, 2020.
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Affiliation(s)
- Matthew R Skalski
- From the Department of Radiology, Palmer College of Chiropractic-West Campus, 90 E Tasman Dr, San Jose, CA 95134 (M.R.S.); Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, Calif (G.R.M.); and Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (D.B.P., A.T., E.A.W., J.S.G.)
| | - George R Matcuk
- From the Department of Radiology, Palmer College of Chiropractic-West Campus, 90 E Tasman Dr, San Jose, CA 95134 (M.R.S.); Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, Calif (G.R.M.); and Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (D.B.P., A.T., E.A.W., J.S.G.)
| | - Dakshesh B Patel
- From the Department of Radiology, Palmer College of Chiropractic-West Campus, 90 E Tasman Dr, San Jose, CA 95134 (M.R.S.); Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, Calif (G.R.M.); and Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (D.B.P., A.T., E.A.W., J.S.G.)
| | - Anderanik Tomasian
- From the Department of Radiology, Palmer College of Chiropractic-West Campus, 90 E Tasman Dr, San Jose, CA 95134 (M.R.S.); Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, Calif (G.R.M.); and Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (D.B.P., A.T., E.A.W., J.S.G.)
| | - Eric A White
- From the Department of Radiology, Palmer College of Chiropractic-West Campus, 90 E Tasman Dr, San Jose, CA 95134 (M.R.S.); Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, Calif (G.R.M.); and Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (D.B.P., A.T., E.A.W., J.S.G.)
| | - Jordan S Gross
- From the Department of Radiology, Palmer College of Chiropractic-West Campus, 90 E Tasman Dr, San Jose, CA 95134 (M.R.S.); Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, Calif (G.R.M.); and Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (D.B.P., A.T., E.A.W., J.S.G.)
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Srinivasan M, Torres JE, McGeary D, Nagpal AS. Complementary and Alternative (CAM) Treatment Options for Women with Pelvic pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 8:240-248. [PMID: 33585075 DOI: 10.1007/s40141-020-00264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose of review I.To provide an overview of the current complementary and alternative (CAM) treatment options for women with chronic pelvic pain (CPP). Recent findings II.Recent studies on chronic pain at cellular, molecular and network level and their interaction with the immune system has unfolded several mechanisms for pain making it promising to explore the alternative paradigm to manage the incredibly complex chronic pelvic pain condition where multifactorial etiology often limits successful outcomes. Summary III.The multifactorial nature and complexity in establishing the underlying diagnosis in CPP limits predictable response to traditional medical and interventional options. Complementary and alternative options have been studied to improve outcomes. Incorporation of exercise-based CAM, pelvic floor physical therapy, acupuncture and cognitive behavioral therapy are suggested to show promising results but well powered randomized studies are needed to draw conclusions on their efficacy. Evidence for non-opioid alternatives such as oral cannabinoids are preliminary and may emerge to be safe and effective.
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Affiliation(s)
- Malathy Srinivasan
- Department of Physical Medicine and Rehabilitation, Sidney Kimmel Medical College at Thomas Jefferson University
| | | | - Donald McGeary
- Associate Professor and Vice Chair for Research, Rehabilitation Medicine; Associate Professor, Psychiatry, UT Health San Antonio
| | - Ameet S Nagpal
- UT Health San Antonio, Department of Anesthesiology, Associate Professor, Department of Anesthesiology, Medical Director, UT Health San Antonio Pain Consultants, Associate Program Director, UT Health San Antonio Pain Medicine Fellowship
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11
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Coccydynia-A comprehensive review on etiology, radiological features and management options. J Clin Orthop Trauma 2021; 12:123-129. [PMID: 33716437 PMCID: PMC7920198 DOI: 10.1016/j.jcot.2020.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/10/2020] [Accepted: 09/20/2020] [Indexed: 11/20/2022] Open
Abstract
Coccydynia is a disabling condition characterized by pain in the coccyx region of the spine. The first description of the disease was given in as early as 1859. Since then a number of theories have been proposed by various researchers to explain the pathogenesis of the disease. Treatment options for coccydynia include ergonomic adaptation, manual therapy, injections and surgery. Despite being identified as a disease as early as 18th century, several uncertainties with respect to the origin of pain, predisposing factors and treatment outcomes of a wide range of treatment options persist till date. The current narrative review presents various aspects of the disease including pathoanatomy, clinical presentation, radiological features and management options for the disease.
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12
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Ahadi T, Raissi GR, Hosseini M, Sajadi S, Ebadi S, Mansoori K. A Randomized Clinical Trial on the Effect of Biofeedback on Pain and Quality of Life of Patients With Chronic Coccydynia. Basic Clin Neurosci 2020; 11:753-763. [PMID: 33850612 PMCID: PMC8019848 DOI: 10.32598/bcn.11.6.1553.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/10/2018] [Accepted: 10/02/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Pelvic floor muscles dysfunction is one of the most important etiologies of coccydynia; therefore, manual therapies have been proposed as the first line of treatment. The purpose of this study was to investigate the effect of biofeedback as a new approach in the treatment of coccydynia. Methods Thirty women were randomized into two groups. Both groups were injected with the corticosteroid. One group received pelvic floor muscle exercises plus biofeedback while the other group only performed exercises. The patient's pain was measured using the Visual Analog Scale (VAS) in the first visit and after 1, 2, and 6 months of follow-up as well as Dallas pain and SF-36 quality of life questionnaires before and 2 months after the treatment. Results Pain had improved significantly after 1, 2, and 6 months in both groups compared to the baseline. However, the amount of change was not different between the groups at any time interval. The results were the same for the Dallas pain scale and SF-36 quality of life questionnaire. Conclusion Adding biofeedback to pelvic floor muscle exercises did not lead to any further improvement in the management of chronic coccydynia. Further studies with larger sample sizes may reveal the effect of biofeedback more clearly.
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Affiliation(s)
- Tannaz Ahadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Raissi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Hosseini
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Sajadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Safoora Ebadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Korosh Mansoori
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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13
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Coccydynia: Diagnostic and Management Guidance. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Foye PM, Araujo MR, Sidhu GJS. Steroids further improve ganglion impar blocks for coccyx pain (tailbone pain). Korean J Pain 2020; 33:400-401. [PMID: 32989205 PMCID: PMC7532290 DOI: 10.3344/kjp.2020.33.4.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Patrick M Foye
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marielle R Araujo
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gurbind Jussa S Sidhu
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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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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Abdel-Aal NM, Elgohary HM, Soliman ES, Waked IS. Effects of kinesiotaping and exercise program on patients with obesity-induced coccydynia: a randomized, double-blinded, sham-controlled clinical trial. Clin Rehabil 2020; 34:471-479. [PMID: 31918574 DOI: 10.1177/0269215519897414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effect of kinesiotaping and a designed exercise program versus sham kinesiotaping and the same exercise program on pain, range of motion, and activities of daily living in obese patients suffering from coccydynia. DESIGN A double-blinded, randomized, sham-controlled trial. SETTING Outpatient, Cairo University hospitals. PARTICIPANTS Sixty patients with coccydynia randomized equally into kinesiotape plus exercise and sham kinesiotape plus exercise groups. INTERVENTION The kinesiotape was worn for three days and replaced for three weeks. Each patient practiced exercises for three weeks. OUTCOME MEASURES All patients were examined by visual analogue scale (VAS) for rating pain, Modified Modified Schober Test (MMST), and Oswestry Disability Index (ODI). All outcomes were measured at baseline, three weeks postintervention, and four weeks follow-up. RESULTS There were no statistically significant differences between groups at baseline (P < 0.05), but there were statistically significant differences between groups for pain score, MMST, and ODI at post and follow-up data in favor of the kinesiotape group (P < 0.001). For the three weeks postintervention, mean (SD) for pain score, MMST, and ODI was 33.07 ± 3.8, 6.6 ± 0.7, and 8.7 ± 2.1 in the study group and 39.9 ± 4.7, 5.8 ± 1.4, and 14.4 ± 2.7 in the control group, respectively. For the four weeks follow-up, mean (SD) for pain score, MMST, and ODI was 32.2 ± 3.4, 7.13 ± 0.6, and 7.2 ± 1.8 in the study group and 40.9 ± 4.4, 6.6 ± 0.75, and 13 ± 2 in the control group, respectively. CONCLUSION Experimental kinesiotape intervention and exercise program provided significant improvements in pain, range of motion, and disability. It is suggested as an adjunctive therapy in treating obese patients with coccydynia.
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Affiliation(s)
- Nabil Mahmoud Abdel-Aal
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hany Mohamed Elgohary
- Department of physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Elsadat Saad Soliman
- Department of Physical Therapy for Musculoskeletal Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Intsar Salem Waked
- Department of physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment. Clin Obstet Gynecol 2019; 62:22-36. [PMID: 30383545 DOI: 10.1097/grf.0000000000000412] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options.
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Yuan X, Bevelaqua AC. Buttock Pain in the Athlete: the Role of Pelvic Floor Dysfunction. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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The role of nonpharmacologic therapies in management of chronic pelvic pain: what to do when surgery fails. Curr Opin Obstet Gynecol 2018; 29:231-239. [PMID: 28604402 DOI: 10.1097/gco.0000000000000376] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW To provide an update on nonsurgical and nonpharmacologic strategies for the management of chronic pelvic pain (CPP). RECENT FINDINGS Effective treatment of patients with CPP requires a multifaceted approach, with thoughtful consideration of surgical, pharmacologic, and nonpharmacologic strategies. Evidence for physical therapy and trigger point injections for treatment of myofascial components of CPP is increasing. Neuromodulation techniques, such as percutaneous tibial nerve stimulation and transcutaneous electrical stimulation, have limited but favorable preliminary data in patients with CPP. Behavioral strategies, such as exercise, cognitive behavioral therapy, and mindfulness, have demonstrated significant improvements in pain, function and quality of life in patients with a variety of chronic pain conditions and are promising avenues for future research in CPP. SUMMARY Nonpharmacologic therapies are important adjuncts to surgical and pharmacologic treatment for CPP and should be considered integral to a comprehensive treatment approach.
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Current Treatments for Coccydynia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kleimeyer JP, Wood KB, Lønne G, Herzog T, Ju K, Beyer L, Park C. Surgery for Refractory Coccygodynia: Operative Versus Nonoperative Treatment. Spine (Phila Pa 1976) 2017; 42:1214-1219. [PMID: 28800569 DOI: 10.1097/brs.0000000000002053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE To evaluate the long-term outcomes for patients with refractory coccygodynia treated with coccygectomy compared to a nonsurgical regimen of sitting aids, physical therapy, medications, and injections. SUMMARY OF BACKGROUND DATA The surgical treatment of coccygodynia remains controversial. To date, there has only been one small comparative study of surgical versus nonsurgical treatment. METHODS From 2004 to 2014, 109 patients presenting with coccygodynia were treated with either total coccygectomy or a nonsurgical course of sitting aids, physical therapy, anti-inflammatory medications, and injections. All had at least 2 years of symptoms before surgery. The patient principally made the treatment decision, counseled by the treating physician. Before surgery, all subjects underwent at least 2 years of conservative treatment and three-dimensional imaging (computed tomography and/or magnetic resonance imaging). Subjects completed visual analog pain scales, EuroQol five-dimension, components of the PROMIS measure, and a novel Coccygodynia Disability Index evaluation. Work status, complications, and satisfaction were recorded. RESULTS A total of 61 patients received nonsurgical care; eight declined participation and five could not be located. Forty-eight patients underwent total coccygectomy; three declined participation and five could not be located. At an average 4.8 years of follow-up (range: 2-9), the nonsurgical visual analog pain scales was 5 and the surgical 2 (P = 0.001); 79% of surgically treated patients were improved at 2 years versus 43% for the nonsurgical group. EuroQol five-dimension (P = 0.002), Coccygodynia Disability Index (0.01), and PROMIS Pain interference scores (0.02) were also significantly improved in the surgical group. Eleven surgical patients (26%) had complications, all wound related with successful resolution; seven treated with dressing changes and four with surgical debridement. CONCLUSION Total coccygectomy is a safe and effective surgical treatment of coccygodynia refractory to nonoperative care. Patient-reported outcome measures were improved after surgery compared with nonsurgical management. Postoperative wound care remains a concern. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- John P Kleimeyer
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - Kirkham B Wood
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - Greger Lønne
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Lillehammer, Norway
| | - Tyler Herzog
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kevin Ju
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lisa Beyer
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christine Park
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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