(Kiosk 5) Ganglion Impar Blocks for Chronic Coccydynia: A Case Series

Case Diagnosis: Chronic coccydynia unresponsive to initial conservative management, then treated with ganglion impar injection.

Case Description: We present three female patients with chronic coccydynia for over one year. Two have confirmed dislocated or fractured coccyx and one had a history of tailbone trauma from falling on buttocks 20+ years ago. One patient had prior difficult delivery requiring forceps and perineal sutures. They received ganglion impar injections after unsatisfactory response to physical therapy and pharmacologic management.

Discussion: Chronic coccydynia mimics other pain syndromes including chronic pelvic pain syndrome and low back pain. While tailbone trauma may precede coccydynia, it is not always the case. The initial management involves pain medications, heat or ice on the affected area, and pelvic floor physical therapy. Ganglion impar blocks can provide both diagnostic value and/or therapeutic benefits for those patients with coccygeal instability and refractory pain. Additionally, psychotherapy should be considered for stress and anxiety management in these chronic pain patients.

Setting: Academic medical center outpatient clinic

Assessment/Results: One patient reported minimal relief after the initial injection and was referred to Orthopedic surgery for evaluation of incidental finding of dislocated coccyx. The other two patients reported 6-8/10 pain pre-injection and 0-1/10 pain post-injection on visual analog score. They remained pain-free for 2-4 months after their initial injections. These results support that the Ganglion of Impar is a viable target for pain relieving interventions to treat coccydynia.

Conclusion: Coccydynia is difficult to treat because the etiologies are often multifactorial. Ganglion impar blocks are an efficacious method of reducing pain for patients who don't respond to initial management.However, it is important to inform patients that pain relief may only be temporary and treatments including pelvic floor physical therapy and psychological intervention should also be incorporated to maximize care in patients with coccydynia. This case series may help guide future interventional methods for controlling coccydnia.