From the Research
The initial management for coccydynia should focus on conservative measures, including activity modification, NSAIDs, and physical therapy, as these interventions address the underlying causes of the pain and avoid more invasive procedures that carry additional risks. The management of coccydynia can be broken down into several key components:
- Activity modification to avoid prolonged sitting and reduce pressure on the coccyx, such as using a donut-shaped cushion or wedge pillow
- Prescribing NSAIDs, such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily, for pain relief and to reduce inflammation, typically for 1-2 weeks 1, 2
- Local ice or heat application for 15-20 minutes several times daily to provide additional relief
- Physical therapy focusing on pelvic floor relaxation exercises and stretching, which may be beneficial for patients with coccydynia 3 For persistent pain, consider a local injection of corticosteroid, such as triamcinolone, which has been shown to have a greater effect than betamethasone 4. It is essential to note that most cases of coccydynia (about 90%) resolve within weeks to months with conservative measures, and these interventions should be recommended first 2, 5. The pain typically results from trauma, inflammation, or muscle tension in the area, and these treatments address the underlying causes while avoiding more invasive procedures that carry additional risks. In cases where conservative measures fail, further interventions, such as coccygectomy, may be considered, but the evidence for these procedures is limited, and high-level, comparative studies are lacking 3.