Fergie-Ross Montero-Cruz, DO, and Steve M. Aydin, DO.
Source: Interventional Pain Management 2018;183-188.
BACKGROUND: Coccydynia is pain in the coccyx region. The most common cause of coccydynia is trauma, either from a direct axial force such as during a fall onto the coccyx or from cumulative trauma as a result of poor sitting mechanics. Risk factors include obesity, female gender and rapid weight loss. The anatomy of the region is not well vascularized, and consists of the coccyx bones, and supporting ligaments and tendons. For a majority of patients, conservative management may be successful but for the remainder of patients, pain relief may only be transient and pain can become debilitating. What has yet to be fully explored is the possible beneficial effect of local injection of platelet-rich plasma (PRP) for the treatment of refractory coccydynia. PRP injections have been successful in treating a variety of chronic tendon, ligament and bone injuries by inducing an inflammatory response to promote or re-initiate healing. In addition, local injections of PRP to the coccyx would be a less invasive option than surgery for patients who have exhausted all other treatment options and continue to struggle with the debilitating effects of coccydynia.
OBJECTIVES: To demonstrate the important role of PRP therapy in treating coccydynia refractory to traditional conservative management.
STUDY DESIGN: Retrospective case series.
METHODS: Three patients with coccygeal pain for greater than 6 months who presented to an outpatient pain management office in New York from 2014 until 2016, and failed conventional treatments. When the pain was deemed refractory for the patient, offering for PRP was done. This was presented with the option to repeat once again at the 6-8 week mark if needed. All patients underwent PRP with fluoroscopic injection, and the use of the same PRP commercially available system; Magellan-Arteriocyte. The patients were evaluated with a numerical rating scale, and percentage of pain relief at 6-8 week post-injection, 6 months post-injection, 12 months post-injection, and 24 months post-injection was recorded. Percentage of pain relief was then calculated.
RESULTS: Overall the patient series demonstrated significant improvement in numeric pain scale, as well as percentage of pain reduction. At the 6-8 week follow-up for all the post-PRP injections, there was an average of 75% improvement in overall pain. At 6 months, 1 patient had no change, while 2 patients maintained the same reduction in pain at the 12- and 24-month follow-ups.
LIMITATIONS: This retrospective case series is only a small sample size of patients with refractory coccydynia.
CONCLUSIONS: Here we discuss the first case series of PRP for coccydynia. The results of the 3 patients in this case series are encouraging.