Comparison of treatment outcomes in chronic coccygodynia patients treated with ganglion impar blockade versus caudal epidural steroid injection: a prospective randomized comparison study

Abstract

Background: Coccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia. Methods: This study was a prospective randomized comparison study conducted between June 2019 and January 2021. Patients diagnosed with chronic coccygodynia were randomly divided into two groups: the GIB group and the CESI group. The severity of pain, presence of neuropathic pain, and quality of life were evaluated using the Numeric Rating Scale, Leeds Assessment of the Neuropathic Symptoms and Signs Scale, and Short Form-12 Health Survey (SF-12), respectively. Results: A total of 34 patients in each group were included in the final analyses. While there was a significant decrease in pain intensity in both groups in the 3-month follow-up, this decrease was more significant in the GIB group at the 3rd week. There was a significant improvement in the SF-12 physical score and the number of patients with neuropathic pain in both groups in the 3rd week, but this improvement was not observed in the 3rd month. Conclusions: Although GIB may provide more pain relief in short term, both GIB and CESI are useful treatment methods in coccygodynia unresponsive to more conservative treatments.

Ultrasound‐Guided Coccygeal Nerve Radiofrequency Ablation and Steroid Injection: Combination Therapy for Coccydynia

“…In a study by Sencan et al, when CESI was compared with GIB, it was concluded that GIB was more effective for short-term pain relief. 10 In a study by Kaya et al, the addition of caudal epidural steroid injection to GIB in patients with coccydynia did not contribute to pain relief. 11 Although CESI and GIB are frequently used for the treatment of coccydynia, they are associated with a risk of complications.…”

“…CESI are frequently used in the treatment of coccydynia, although there is insufficient evidence to support this. In a study by Sencan et al, when CESI was compared with GIB, it was concluded that GIB was more effective for short‐term pain relief 10 . In a study by Kaya et al, the addition of caudal epidural steroid injection to GIB in patients with coccydynia did not contribute to pain relief 11 …”

Ganglion Impar Block for Chronic Coccydynia

“…14 The techniques for blocking ganglion impar in the past used bent and curved needles, which are associated with significant discomfort, tissue damage, and high risk of rectal perforation. 9 The study made use of a straight spinal "needle inside needle" approach to avoid above mentioned problems and to mitigate the risk of discitis and incidence of needle breakage. The trans-sacrococcygeal "needle inside needle" approach adopted in this study is better than the classical and paramedian approach to the ganglion, and is a technically possible means which is easy to learn and perform.…”

“…Fluoroscopy, can be applied using a Plancarte or transsacrococcygeal technique, or using an ultrasound guidance. 9 However, there is no evidence that which fluoroscopy technique is most effective and mainly depends on physician's preference. This study was carried out to contribute to existing literature to demonstrate the effectiveness of using fluoroscopy-guided transsacrococcygeal ganglion impar block to treat coccydynia.…”

Evaluation of the effectiveness of caudal epidural steroid injection as an adjuvant to ganglion impar pulsed radiofrequency therapy in chronic coccygodynia

“…It has been suggested that the mechanism underlying the neuromodulatory effects of PRF arises from the electromagnetic field it produces and is related to increased activity of the noradrenergic and serotonergic descending pathways [ 4 , 5 ]. In another study, both GIB and CESI were shown to be useful treatment methods in coccygodynia nonresponsive to conservative treatments [ 6 ]. In our review of the literature, we found no study comparing the effectiveness of GI-PRF therapy with and without adjuvant CESI in chronic coccygodynia.…”