From the Research
Management of coccygeal pain typically begins with conservative measures including NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain relief and to reduce inflammation, as recommended by the most recent study 1. The goal of treatment is to alleviate pain, reduce inflammation, and improve quality of life.
- Patients should avoid sitting on hard surfaces and use a donut-shaped cushion or wedge pillow to reduce pressure on the tailbone.
- Local heat or ice application for 15-20 minutes several times daily can provide relief.
- Physical therapy focusing on pelvic floor relaxation exercises and stretching may help reduce muscle tension contributing to pain.
- For persistent cases, a local injection of corticosteroids (such as methylprednisolone 40mg with lidocaine) around the coccyx may be beneficial, as suggested by 1. Most cases resolve within weeks to months with these approaches.
- Surgery (coccygectomy) is rarely needed and reserved for severe cases unresponsive to conservative treatment after 6-12 months, as indicated by 1. Coccygeal pain often results from trauma like falls or childbirth that causes inflammation, fracture, or dislocation of the coccyx, or from prolonged sitting on hard surfaces. Addressing the underlying cause while providing symptomatic relief is the cornerstone of effective management, and the use of NSAIDs like ibuprofen is supported by studies such as 2 and 3, which demonstrate their effectiveness in pain management. However, it is essential to consider the potential for under-dosing, as highlighted by 3, to ensure optimal pain relief. Additionally, the comparison of different pain management strategies, such as the use of acetaminophen versus ibuprofen, as discussed in 4 and 5, can inform treatment decisions. Overall, a comprehensive approach to managing coccygeal pain, incorporating conservative measures and considering the latest evidence, is crucial for improving patient outcomes.