From the Research
The best treatment for non-traumatic coccyx pain (coccydynia) typically involves a multimodal approach starting with conservative measures, as supported by the most recent and highest quality study 1. This approach is crucial in managing coccydynia, given its potential to reduce morbidity, mortality, and improve quality of life.
Key Components of Conservative Management
- Using cushions specifically designed for coccyx relief (donut or wedge cushions) to reduce pressure when sitting
- Over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs such as ibuprofen (400-600mg three times daily with food) to manage pain and inflammation
- Physical therapy focusing on pelvic floor relaxation exercises, manual therapy, and stretching of the surrounding muscles
- Local heat or ice application for 15-20 minutes several times daily for relief
Considerations for Persistent Pain
For patients with persistent pain, a physician might consider corticosteroid injections into the sacrococcygeal joint, although the evidence for injection-based therapy is not as strong 1.
Role of Surgery
Surgery (coccygectomy) is rarely needed and only considered when severe pain persists despite 6+ months of conservative management, as it carries risks such as infection 2.
Importance of Multidisciplinary Approach
A multidisciplinary approach, including physical therapy, ergonomic adaptations, medications, and possibly psychotherapy, leads to the greatest chance of success in patients with refractory coccyx pain 3. Given the variability in patient response and the lack of high-quality evidence for some treatments, a tailored approach considering the individual's specific needs and circumstances is essential.