What Is A Coccygeal Nerve Block?
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A coccygeal nerve block is a minimally invasive treatment approach for chronic pain in the lower back, specifically in the rectum and the tailbone. This area is also known as the coccyx. Lower back pain will affect almost everybody at some point. People in the U.S. spend about $50 billion a year on treatments for back pain.
What causes back pain?
If you’re experiencing lower back pain, it’s not always easy to identify the exact cause or exact place where you’re experiencing pain. Due to the way the back works, there are multiple risk factors and causes that could be contributing to your pain.
To start, certain conditions or injuries may clearly be the cause of your back pain. When this is not the case, there may be a number of other conditions that could cause serious and persistent back pain. These include:
One particular condition, known as coccydynia, leads to pain in the coccyx, but it is more rare.
Conditions Related To Coccygeal Nerve BlocksUnderstanding the anatomy of the coccyx or tailbone can help you understand the conditions that benefit from 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. Possible causes of coccydynia, or risk factors, include:
- Degeneration, or the gradual wear-and-tear of the bones that make up the coccyx
- Sitting for long time periods
- Using poor posture while sitting
- A serious accident, such as a fall
Clinical studies show 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.
Diagnosing back pain
Diagnostic procedures can help pinpoint the reason for your pain. To do this, your doctor may use:
- Physical examinations
- Patient history assessments
- Imaging screenings, such as MRIs and X-rays
- Spinal tests
If the results of the diagnostic evaluation are inconclusive, then a doctor may assess whether a more rare condition (e.g., coccydynia) is causing your discomfort. In particular, if a patient reports that their lower back pain is accompanied by dull, painful throbbing in their tailbone this may indicate coccydynia.
How Is A Coccygeal Nerve Block Performed?If your doctor finds that coccydynia is contributing to your pain, they may suggest a coccygeal nerve block. This procedure targets nerve roots in the saccroccygeal junction that regulate pain signal transmission to the area of the coccyx.
In preparation for a coccygeal nerve block procedure, your doctor will have you lay facedown on a procedure table. Next, your healthcare team with sterilize the skin thoroughly. They’ll also use a monitor that records your heart rate, breathing, and blood pressure.
If you and your doctor decide it’s the best choice, they’ll start intravenous anesthesia (an IV drip) at this point as well. Intravenous anesthesia is not actually required for this procedure. If it is not used, your doctor will apply a topical anesthetic to the lower back instead before the nerve block begins.
Your doctor then uses an X-ray to guide the insertion of the needle into the appropriate nerve area. This real-time X-ray is called a fluoroscope. Once the needle is in place, they’ll inject a dye in the area 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.
The steroid can decrease your inflammation, while the anesthetic reduces your pain. When effective, the combination of these two medications blocks nerves from transmitting pain signals.
Coccygeal nerve block benefits
A coccygeal nerve block can provide significant pain relief for individuals who are suffering from true tailbone pain.
Furthermore, clinical research has shown that chronic pain in those patients who have undergone rectal cancer surgery dramatically decreases if these patients receive a coccygeal nerve block. This is especially helpful if the doctor administers medication directly to the sacrococcygeal area.
This form of nerve block can be useful for diagnostic purposes as well. For instance, if tailbone pain decreases after the procedure, it confirms the correct diagnosis of coccydynia.
Coccygeal nerve block risks
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 at the injection site
- Tingling or numbness in the extremities
- Nerve damage that may occur due to a needle puncture, in rare cases
ConclusionCoccygeal nerve blocks are 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. If you’re suffering from pain, you can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.
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- Foye PM Lorenzo C. Coccyx pain treatment and management. Medscape http://emedicine.medscape.com/article/309486-treatment. Accessed January 2, 2014.
- 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.