What is a Coccygeal Nerve Block?
Coccygeal Nerve Blocks Performed by Las Vegas, Summerlin, and Henderson Nevada’s Top Pain Doctors
The root of chronic back pain is often difficult to diagnose. This is often frustrating for patients as well as clinicians. Most of the available literature describes well-known conditions, such as herniated discs, sciatica, and spinal stenosis; however, conditions such as coccydynia, which causes pain in the coccyx region, are not documented as frequently.
Patient history evaluations concerning symptoms, imaging studies, and spinal diagnostic procedures can be successful in locating the source of the pain. However, in some cases they fail to locate the exact cause. In these cases, other conditions, such as coccydynia, should be considered, especially if the lower back pain is accompanied by a dull ache high in the rectum.
How Is a Coccygeal Nerve Block Performed?Patients are first positioned face-down on an x-ray table. The skin is then sterilized and prepared for the injection. If IV sedation is used, vital signs such as blood pressure, heart rate, and breathing are monitored. Once the skin is sterile, a local anesthetic is used to numb the skin prior to the nerve block.
The physician will then insert a combination of anesthetic and a long-lasting steroid medication into the sacroccygeal junction. During the injection, the doctor uses a special real-time x-ray, known as a fluoroscope, to guide the needle. This helps deliver the steroid medication as close as possible to the aggravated and inflamed nerve root. Once the contrast dye locates the exact area, the doctor injects the anesthetic and steroid medication. The procedure takes approximately fifteen minutes.
Patients who suffer from true pain in the sacrococcygeal junction can have immediate relief from a successful coccygeal nerve block. Past research published in the Journal of Anesthesia reported that coccygeal nerve block injections into the sacroccygeal ligaments for pain related to rectal cancer surgery were extremely effective in stopping perineal pain. The therapeutic injection can also confirm that the diagnosis of coccydynia was correct.
Coccygeal nerve blocks are considered minimally invasive procedures; however, as with all procedures, there is some risk of complications, which include nerve damage, bleeding, numbness in the extremities, and infection.
Conditions Related To Coccygeal Nerve BlockTo better understand what conditions a coccygeal nerve block can treat, it helps to know the anatomy of the tailbone, or coccyx. The coccyx is below the sacrum at the base of the spine. The word coccyx is derived from a Greek word for cuckoo. The term was coined due to the tailbones similar shape to that of a cuckoo bird’s beak. The word tailbone was named because of the location of the coccyx at the “tail” of the spine. The coccyx is a group of three to five individual segments, which curve into a narrow tip. The primary functions of the coccyx are to bear the weight of the body and act as an attachment point for ligaments, tendons, and muscles.
Coccyx pain (coccydynia) is often described as a dull ache high in the rectum. The pain may also radiate to the lower back, buttocks, and legs. It is typically caused by degeneration of the bones at the base of the spine. Long periods of sitting and poor posture place stress on the coccyx, which sometimes culminates in coccydynia. Research has shown that relief can be felt as quick as a few minutes after the injection of a coccygeal nerve block. When this happens, it confirms that the pain present in that area was due to coccydynia.
Minimally invasive coccygeal nerve blocks may be a viable non-surgical option to help relieve lower back pain. A doctor who specializes in pain management can work with patients to help determine if the coccygeal nerves are the source of chronic pain in the tailbone area.
- Foye PM. Finding the cause of coccydynia (coccygeal pain). J Bone Joint Surg Br. 2007;31(3):427.
- Foye PM Lorenzo C. Coccyx pain treatment and management. Medscape http://emedicine.medscape.com/article/309486-treatment. Accessed November 8, 2013.
- 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.
- 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.