Management of coccygodynia: talking points from a systematic review of recent clinical trials

Coccygodynia, characterised by localised pain in the coccyx and surrounding tissues, presents challenges in diagnosis and management given its low prevalence and varied aetiology. Traumatic injury, particularly backward falls, is commonly implicated, while non-traumatic causes include degenerative joint disease, overloading stress forces from obesity and morphological variations of the coccyx. Diagnostic evaluation involves medical history, physical examination, and radiographic imaging. While conservative management is often successful, refractory cases necessitate intervention. However, optimal treatment strategies still need to be clarified. The present systematic review discusses the clinical evidence on the management of coccygodynia.

In December 2024, a systematic review followed PRISMA guidelines, accessing PubMed, Web of Science, and Embase databases. Eligible studies included solely clinical trials investigating coccygodynia management. The risk of bias was assessed using Cochrane risk of bias assessment tool (RoB2) for randomized controlled trials (RCTs) and the Risk of Bias in nonrandomized Studies of Interventions (ROBINS-I) for non-RCTs. Data extraction and statistical analyses followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.

Of 407 identified articles, 16 met inclusion criteria, comprising 858 patients, primarily women. Risk of bias assessment revealed varying methodological quality among included studies. Conservative treatments, including physiotherapy and shockwave therapy, showed promise in pain management. Interventional therapies, such as corticosteroid injections and ganglion-impair blockade, demonstrated efficacy in refractory cases. Surgical interventions, particularly coccygectomy, yielded moderate success rates but were associated with notable risks.

A multidisciplinary approach is advocated for managing coccygodynia, with conservative measures as initial strategies. Physical therapy-based interventions and interventional treatments, such as corticosteroid injections and ganglion impair blockade, offer viable options for refractory cases. Surgical intervention should be considered judiciously, weighing risks and benefits based on patient-specific factors and treatment response. Further research is needed to establish standardized guidelines for coccygodynia management based on high-quality evidence.