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Contemporary Management of Coccydynia
Victor E Staartjes1,2,3, Daniel De Wilde3, Aron Alakmeh3
1Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands Väsby, Sweden.
Neurospine
|May 7, 2026
Summary
Coccydynia (tailbone pain) diagnosis and treatment are often inconsistent. This review offers a framework for evaluation and management, emphasizing conservative care, targeted injections, and reserving surgery for severe, refractory cases.
Area of Science:
- Orthopedics
- Pain Management
- Physical Medicine
Background:
- Coccydynia, or tailbone pain, is often misdiagnosed and managed inconsistently.
- Current evidence on diagnostic and treatment strategies requires synthesis to guide clinical practice.
Purpose of the Study:
- To summarize and grade evidence on diagnostic strategies for coccydynia.
- To propose a best-practice framework for evaluating and managing tailbone pain.
Main Methods:
- Systematic literature search and review of 42 studies.
- Inclusion of studies on conservative, interventional, and surgical management.
- Grading of current evidence for diagnostic and therapeutic approaches.
Main Results:
- Initial assessment involves history, physical exam, and basic radiographs; advanced imaging (MRI/CT) is reserved for specific indications.
- First-line treatments include education, NSAIDs, physiotherapy, and extracorporeal shock wave therapy.
- Image-guided injections and radiofrequency procedures offer relief for persistent pain, guiding selection for surgery.
Conclusions:
- A structured diagnostic and therapeutic framework is proposed based on current evidence.
- Conservative management is the cornerstone, with interventional options for refractory cases.
- Coccygectomy is a last resort for chronic, function-limiting pain unresponsive to other treatments.
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