Coccydynia, commonly called tailbone pain or coccyx pain, is a fairly rare and relatively poorly understood condition that can cause pain in the lower back and buttock areas. The coccyx is the very bottom portion of the spine. It consists of between three to five very small bones called vertebra that are fused together.
– By Stephen Wade, MD, FAAPMR, ABPM
Coccydynia is felt as a localized pain exacerbated by sitting or with any activity that puts pressure on the lower spine. The condition is more common in women than men. Possible underlying causes include trauma from a fall or child birth. A fall on the tailbone can inflame the ligaments or injure the coccyx or the coccygeal attachment to the sacrum. This is probably the most common cause of coccydynia. During childbirth, the baby’s head passes over the top of the coccyx, and the excess pressure created against the coccyx can sometimes cause an injury to the coccyx structures (the disc, ligaments and bones) because these structures move beyond their normal limit. Also, in rare cases a tumor or infection in the coccyx can be a primary cause of tailbone pain. The most important finding on examination is usually the local tenderness upon palpation of the coccyx.
Suggested treatment regimen would begin with conservative options then progress to more aggressive treatments if the pain continues. One of the first treatments for coccydynia would include non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs help reduce the inflammation around the coccyx and that can help the decrease the pain. Placing a cold pack, or heat/hot pack on the painful area may help the pain. It is recommended to be applied on and off for about 20 minutes at a time for the first few days after the pain starts.
Avoiding positions that exacerbate the pain such as sitting for prolonged periods, or placing any pressure on the painful area is recommended. A custom shaped pillow to help take pressure off the coccyx when sitting may help the pain. Some find a donut-shaped pillow works well.
Many prefer a foam pillow that is more of a U-shape or V-shape (with the back open so nothing touches the coccyx). Any type of pillow or sitting arrangement that keeps pressure off the coccyx is ideal.
A Ganglion Impar Block can be performed to help with tailbone pain. Ganglion Impar Block is a block at the ganglion impar, a cluster of nerve cells in front of the joint between the sacrum and the coccyx. To get to this ganglion, a curved needle may be passed superficially up from underneath the coccyx, or a needle may be passed through the sacrum/coccyx joint itself. This block can provide significant pain relief for patients with tailbone pain.
Garden State Medical Center is staffed with the area’s leading pain management specialists. We can work with you to help take better care of your body by promoting healthy joints, staying pain free and becoming more active. Call Dr. Wade today to discuss this condition or any other painful condition you need help with.
For more information about Dr. Wade and GSMC, visit www.gsmedicalcenter.org or call 732-202-3000.