Nerve Ablation for Tailbone Pain

What is nerve ablation?
  • In general, the term “nerve ablation” refers to the intentional destruction of nerves.
  • In patients with tailbone pain or other types of pain, nerve ablation is one way of stopping the pain.
  • Basically, even if the patient continues to have the underlying musculoskeletal abnormality (such as joint arthritis, joint dislocation, bone spur, etc.) the idea is that if you can stop the nerves from carrying pain signals up to the brain then the person the longer suffers from the pain.
  • When the person is no longer suffering in pain then their quality of life improves.
Types of nerve ablation
  • Chemical ablation: as the name implies, chemicals are used to deaden/kill the nerves. Typical chemicals used to kill the nerves include alcohol and phenol.
  • Radiofrequency ablation (RFA): this uses radiofrequency waves to deaden/kill the nerves. the energy from RFA essentially heats up the nerves (essentially cooking them so that they no longer work to carry pain signals).
  • Cryoablation: this uses cold to deaden/kill the nerves. Basically, freezing the nerves kills them.
  • Preferred type of ablation for tailbone pain: Typically if I’m doing nerve ablation to treat tailbone pain I perform chemical ablation using a concentrated form of alcohol (the first option on this list).
“Endoscopic” ablation (Rarely ever done)
  • Let me start by saying that endoscopy is definitely NOT the usual way that ablation injections are done at the coccyx. They are almost never done this way!
  • Endoscopy means that the doctor performing the procedure inserts an endoscope, which is a medical device used to look inside of a patient.
  • Basically this is inserting a thin tube/cable into the patient with a camera on the tip, so the doctor can look inside.
  • Although endoscopy is very commonly used in the other parts of the body (such as an endoscopy to look down the back of the throat and down into the stomach of someone who is suffering from stomach ulcers), endoscopy is rarely (if ever) needed for ablation at the tailbone.
  • Because the tailbone is close to the skin, endoscopy typically should not be needed for looking at the tailbone.
  • Fluoroscopy typically provides a very good look at the tailbone during tailbone injections (including ablation), making endoscopy unnecessary for these procedures.
    • Fluoroscopy almost always makes endoscopy unnecessary for tailbone injections.
  • Compared with a typical coccyx injection, endoscopy requires much more medical equipment and cost, without medical justification for such equipment and cost.
  • Compared with a typical coccyx injection, endoscopy also requires making a much larger hole in the patient’s skin.
    • The reason is that the endoscope for endoscopy is much much thicker/broader than the size of the very thin needle that would normally be used for a tailbone injection.
    • This can result in more tissue trauma to the patient with endoscopy.
    • Also, having a larger hole in the skin (due to endoscopy) can result in increased risk of infection at the procedure site.
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