Multiple different types of injections are done to decrease tailbone pain.
3 of the most common types of tailbone injections:
- Steroid injection: a steroid is an anti-inflammatory medication that can be placed at a site of inflammation, to decrease the inflammation and pain at that location.
- Sympathetic nerve block: Sometimes in addition to the musculoskeletal pain and inflammation there is a component of nerve pain. Performing an nerve block is when the doctor places a local anesthetic (such as lidocaine) onto specific nerves in order to temporarily shut them off. After a few hours when the nerves “wake up” again, the nerves may not be so hyper-sensitive and hyper-irritable. So the nerve pain can be dramatically decreased or even completely resolved.
- Nerve ablation (destruction): if none of the other injections are helping, then one option is to intentionally destroy/kill/deaden the nerves that are carrying pain from a specific site. If the nerves can not carry pain signals from your tailbone, then the pain signals will never be sent to your brain and your quality of life may be dramatically improved.
Sequence of Injections
- Steroid injection: I typically start with a local steroid injection, ideally targeting the specific area that matches the individual patient’s diagnosis. For example, if the pain seems to mainly be coming from a distal coccyx bone spur, then I would target that spot. If the pain seems to be coming mainly from a dislocated or unstable (hyper-mobile) joint then I would target that specific area. (This is why it is so important to have an accurate diagnosis first rather than just injecting without knowing where the pain is coming from.)
- Sympathetic nerve block: Depending on the response to a local corticosteroid injection, I would consider a ganglion Impar sympathetic nerve block. Sometimes I will combine the steroid injection and the ganglion Impar sympathetic nerve block (the steroid helps treat the musculoskeletal pain/inflammation while the nerve block helps treat the nerve pain).
- Nerve ablation (destruction): Most patients will get good relief from either the steroid injection or the sympathetic nerve block. For those who don’t, I consider nerve ablation.
- Repeating injections: If any given injection gives great relief (in terms of the amount of relief and the duration of relief) then that same injection could be repeated if the pain comes back many months or years later.
- Improved relief: In general, these injections can be done under fluoroscopic guidance so that the physician can make sure the medication is placed in the location that is most likely to relieve your tailbone pain.
- Decreased risks: Fluoroscopy also helps the physician to make sure that they do not accidentally inject the medication into an area that would cause complications or side effects.
There are also other types of injections done for tailbone pain, but the 3 noted above are the most common.
Please post below any thoughts, questions, or comments you have about tailbone injections for tailbone pain.
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