Coccygeal Nerve Block
A coccygeal nerve block refers to a minimally invasive treatment approach for chronic pain in the lower back, specifically in the rectum and the tailbone, which is also known as the coccyx. Pain in the lower region of the back affects many individuals. People in the U.S. spend about $50 billion a year on treatments for back pain. The National Institute of Neurological Disorders and Stroke even released a report stating that the only other health issue that is reported more often than backaches is headaches.
The primary reason an individual may be experiencing back pain is not always easy to identify. Certain conditions or injuries may provide a clear indication of the cause of back pain, but when this is not the case, both patients and doctors may become frustrated. There are a number of conditions that are known to cause serious and persistent back pain. These include herniated discs, compression fractures, spinal stenosis, and sciatica. One particular condition known as coccydynia results in pain that is localized in the coccyx, but it is not frequently diagnosed.
Diagnostic procedures that are typically performed in order to help pinpoint the reason for pain include patient history assessments, imaging screenings, and spinal tests. If the results of the diagnostic evaluation are inconclusive, then a doctor may consider assessing whether a more rare condition (e.g., coccydynia) is causing a patient’s discomfort. If a patient reports that low back pain is accompanied by dull, painful throbbing in the tailbone this further indicates the presence of coccydynia.
What is a Coccygeal Nerve Block
How a Coccygeal Nerve Block is Performed
In preparation for the coccygeal nerve block procedure, a patient is positioned facedown on an X-ray equipped table. Next, the skin is sterilized thoroughly and intravenous anesthesia (an IV drip) is administered if it is deemed necessary, along with a monitor that records heart rate, breathing, and blood pressure. Intravenous anesthesia is not actually required for this procedure and if it is not used, a topical anesthetic is applied to the lower back instead before the nerve block begins.
A physician then uses an X-ray to guide the insertion of the needle the medication will be injected through. This real-time X-ray is called a fluoroscope and once the needle has been positioned, a dye is injected in order to observe whether it circulates throughout the correct region. This process ensures that the steroid and anesthetic, which are injected after the proper needle placement has been confirmed, will be administered as close as possible to the affected region. Nerve roots located in the saccroccygeal junction that regulate pain signal transmission are the targets of the nerve block procedure. The steroid decreases the inflammation, while the anesthetic reduces the pain. The combination of these two medications blocks the targeted nerves from transmitting pain signals.
A coccygeal nerve block has been shown to provide significant relief for individuals who are suffering from true tailbone pain. Furthermore, clinical research has shown that chronic pain that has persisted after patients have undergone rectal cancer surgery dramatically decreases if these patients receive a coccygeal nerve block, especially if the medication is administered directly to the sacrococcygeal area. This form of nerve block is used for diagnostic purposes as well. For instance, if pain in the tailbone is relieved after the procedure, it confirms the correct diagnosis of coccydynia.
A coccygeal nerve block is a minimally invasive approach, but as with any other treatment technique, there are certain complications that may arise in rare instances. Possible complications include an infection, bleeding, tingling or numbness in the extremities, and nerve damage that may occur due to a needle puncture.
Conditions Related to ...
The anatomy of the coccyx or tailbone will first be described in order to better explain the conditions that can be treated with a coccygeal nerve block. The coccyx is located directly beneath the sacrum, a large triangular bone at the very bottom of the spine. The word “coccyx” was actually derived from cuckoo, which is a Greek word. After noticing that the tailbone and the beak of the cuckoo bird were quite similar, the term coccyx was coined. The coccyx consists of three to five spinal bones that are fused into one narrow, curved structure. The main purpose of the coccyx is to bear the weight of the body, but it is also the main point of attachment for muscles, ligaments, and tendons.
Coccyx pain, also referred to as coccydynia, is typically described as throbbing pain in the upper tailbone and the rectum. The pain may, however, extend down into the buttocks, the lower back, and even the legs. Degeneration, described as the gradual wear-and-tear of the bones that make up the coccyx, is a common cause of this condition. In addition, sitting for long time periods, using poor posture while sitting, or a serious accident such as a fall may also lead to the development of coccydynia.
Clinical studies have demonstrated that coccygeal nerve blocks have the ability to provide almost immediate relief from this condition once the injection is administered. Furthermore, if the initial coccydynia diagnosis was unclear, a successful nerve block in this region confirms the diagnosis.
Conclusions
A coccygeal nerve block refers to a minimally invasive treatment for chronic lower back and tailbone pain.
Several conditions such as herniated discs, compression fractures, spinal stenosis, and sciatica may cause pain in these regions as well as prolonged poor posture or trauma to the coccyx. A rare condition that causes tailbone pain is called coccydynia, but it is not diagnosed very often.
When this condition is suspected, a coccygeal nerve block may be used for therapeutic and diagnostic purposes to confirm the presence of coccydynia.
A pain management doctor can help a patient determine whether a coccygeal nerve block should be performed in order to treat chronic pain in the coccyx.
References
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Foye PM. Finding the cause of coccydynia (coccygeal pain). J Bone Joint Surg Br. 2007;31(3):427.
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Foye PM Lorenzo C. Coccyx pain treatment and management. Medscapehttp://emedicine.medscape.com/article/309486-treatment. Accessed January 2, 2014.
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Nathan ST, Fisher BE, Roberts CS. Coccydynia: a review of pathoanatomy, etiology, treatment, and outcome. J Bone Joint Surg Br. 2010;92(12):1622-1627.
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Yamada K, Ishihara Y, Saito T. Relief of intractable perineal pain by coccygeal nerve block in anterior sacrococcygeal ligament after surgery for rectal cancer. J Anesth. 1994;8(1):52-54.
