Spinal Cord Stimulator for Coccyx Pain, Tailbone Pain, Coccydynia

  • There is limited published data on using spinal cord stimulators (SCS) for coccyx pain (tailbone pain, coccydynia, coccygodynia).
  • Spinal cord stimulators are MUCH more commonly used for low back pain, including “failed back syndrome” (where people have persistent pain despite lumbar surgery).
  • The general idea for SCS is that stimulating the nerves can essentially cause your body to start to “ignore” sensations coming from a given body region. Just like you start to ignore the sensation of your shirt sleeve on your arm because it is a gentle sensation that has been present there for many hours. So, if you can stimulate the nerves receiving sensation from a painful area, perhaps you can train your body to start to ignore sensations (including pain) from that area.
  • The physician placing the spinal cord stimulator needs to decide the best place to put the electrodes. The electrodes need to be placed at the specific level of the spinal cord that is receiving the incoming pain signals. So, if you have pain signals coming from your leg or lower back, then the doctor needs to figure out what level of the spinal cord those pain fibers will enter at. Then, the doctor can target that specific level of the spinal cord by placing an SCS electrode at that site.
  • So, you can think of it as there being TWO very different and very important locations: 1) The anatomic location that the pain is coming from, and 2) the anatomic location where the nerves carrying those pain signals are entering the spinal cord.
  • Typically, for pain that is coming from the lower back region (lumbosacral spine) the spinal cord stimulator electrode needs to be placed up into the thoracic spine.
  • For  pain coming from the lumbar spine, it is relatively predictable where the electrodes will need to be placed (i.e., the doctor can usually figure out where specifically the electrodes need to be put, such as putting the electrodes at certain specific levels within the thoracic spine).

 

  • Unfortunately for coccyx pain things are not quite so clear. There is FAR less published literature on using spinal cord stimulation to treat coccyx pain. So, is not as well-established to know what are the specific anatomic levels where the electrodes should be placed in order to cover the coccyx.
  • Also, within the spinal cord,  the nerve levels that cover the coccyx are relatively nearby to the nerves from the anal and other pelvic regions. So, using the electrode to stimulate the nerves carrying pain from the coccyx might also cause the patient to feel unpleasant tingling or similar sensations in the area of their anus or similar pelvic sites.

 

  • TRIAL: Typically, regardless of the painful site that the doctor is trying to cover, what is done first is a “trial” where they put the electrical leads at the targeted levels of the spinal cord. Then, the patient and their doctor can see whether stimulating those electrodes gives good relief or not.
  • TRIAL versus PERMANENT: The main difference between a “trial” SCS and a “permanent” SCS is that the trial is just temporary. For the trial, the electrodes are put in place but the battery pack for the stimulator is OUTSIDE of the patient (e.g., the patient can wear the battery on a belt around their waist, while the wires from the battery go through their skin and into their spine all the way to the electrode that is stimulating the spinal cord). That is usually okay to do for a few days. But because the wires are going from externally (from the external battery pack) to internally (to the electrodes within the patient’s spine), there is the potential for infection to travel along the wires. This could carry bacteria and other microorganisms from your skin into your spine, which would cause a serious infection. So, after a few days the patient and their doctor need to make a decision as to whether the spinal cord stimulator is providing enough relief to justify having a small surgical procedure to put the battery inside the patient. If so, a battery pack is placed underneath the patient’s skin. Placing the battery pack internally (inside the patient) is considered a “permanent” placement of the spinal cord stimulator. However, the term “permanent” is relative, because after years of use the battery can eventually die and need to be replaced. Also, if the electrodes move (migrate) over time, then they may no longer cover the area where you’re trying to get relief.

 

  • Most of the information above is regarding using a spinal cord stimulator to treat low back pain (lumbar pain) or irritation of the lumbar or lumbosacral nerve roots (which can travel down the leg causing “sciatica” pain shooting into the leg).
  • However, as noted at the start of this article, it is MUCH less common to use a spinal cord stimulator to treat specifically coccyx pain. However, this is an area of some small amount of ongoing research. Time will tell whether this may or may not become a more common treatment for tailbone pain.
Patrick Foye, M.D.
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Patrick Foye, M.D.

Founder and Director at Tailbone Pain Center
Dr. Foye is an expert at treating tailbone pain (coccyx pain).

His personable, private-practice office is located on a modern, renowned, academic medical school campus, at Rutgers New Jersey Medical School.

For an appointment, call 973-972-2802.

http://tailbonedoctor.com/
Patrick Foye, M.D.
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