Why Epidural Injections Do Not Help Tailbone Pain (Coccyx Pain)

  • There are many different types of injections that pain management physicians like myself can provide for patients.
  • Often, an important first step is deciding whether any given patient needs an injection at all, and if so which specific type of injection they may benefit from.
What is an epidural steroid injection?
  • An epidural injection is an injection that places medication into the epidural space.
  • The epidural space is located within the spinal canal.
  • Placing steroids into the epidural space may help decrease inflammation at that specific site.
  • For example, if someone has a disc herniation in their lower back causing irritation and inflammation of the disc and epidural space and spinal nerves at that level, they may benefit from injecting an anti-inflammatory steroid into the epidural space at that level.
  • Epidurals can be done at various levels of the spine, including the cervical spine, thoracic spine, and lumbosacral spine.
  • The physician performing the injection can place the needle tip into the epidural space using different approaches or pathways for the needle.
    • Three different approaches include:
      1. Transforaminal epidural
      2. Interlaminar epidural
      3. Caudal epidural
  • However, note that NONE of the approaches above place anti-inflammatory medication at the coccyx.
Why don’t epidural injections help decrease tailbone pain?
  • I have read hundreds of medical articles on tailbone pain, but I do not know of even one single article that has shown epidural steroid injections to be helpful at decreasing tailbone pain.
  • I have also seen *many* patients who have come to see me reporting that they have undergone epidural steroid injections in hopes of getting relief of their tailbone pain, only to receive zero benefit.
  • This is not surprising. As noted above, the epidural space is located within the spinal canal and the spinal canal does not go as low down as the tailbone.
    • There is a spinal canal within the cervical spine, thoracic spine, lumbar spine, and sacrum, but there is NO spinal canal or epidural space within the coccyx.
    • So, if the doctor is injecting a treatment into the epidural space then he or she is not injecting the medication at the tailbone.
Why do doctors do epidural injections for tailbone pain if they do not help?
  • I believe that almost all doctors are trying to do their best to help their patients.
  • Most doctors know very little about coccydynia (coccyx pain, or tailbone pain).
  • Even doctors who specialize in treating painful musculoskeletal conditions often know very little about the causes of tailbone pain, the best of diagnostic tests for tailbone pain, or the best and most current treatments for tailbone pain.
  • So, the doctors provide the treatments that they know how to do.
    • They do epidural injections for tailbone pain because, simply, they know how to do epidural injections.
    • They hope that maybe  the injections will help the patient with tailbone pain, the way that they often see these injections help patients with other kinds of spine pain.
    • Out of all of the different epidural injections, the one that is closest to the coccyx is the “caudal” epidural injection. So maybe the doctor will “try” a caudal epidural steroid injection for a patient with tailbone pain.
    • But when the epidural injections fail to provide relief, the doctor may not understand why were they may not  know what else to do or recommend.
Which injections *are* most helpful for tailbone pain?
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Book: “Tailbone Pain Relief Now! Causes and Treatments for Your Sore or Injured Coccyx” by Patrick Foye, M.D.

Patrick Foye, M.D.
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