Effects of Extracorporeal Shock Wave Therapy on Pain in Patients With Chronic Refractory Coccydynia: A Quasi-Experimental Study

Abstract

BackgroundSeveral nonsurgical and surgical treatment modalities are available for patients with chronic coccydynia, with controversial results. Extracorporeal shock wave therapy (ECSWT) is effective in the treatment of many musculoskeletal disorders; however, it has not been tested for chronic coccydynia.ObjectivesWe performed the current study to determine the effects of ECSWT on pain in patients with chronic coccydynia.Patients and MethodsThis quasi-interventional clinical study included 10 patients with chronic coccydynia without acute fracture. All the patients received ECSWT with a radial probe delivering 3,000 shock waves of 2 bar per session at 21 Hz frequency directed to the coccyx. Each patient received four sessions of ECSWT at one-week intervals. The pain severity was recorded according to the visual analog scale (VAS) at one, two, three, and four weeks after initiation of therapy. The VAS score was also evaluated at one and six months after ending the therapy.ResultsMost of the participants were women (90.0%), and the participants’ mean age was 39.1 ± 9.1 (ranging from 28 to 52) years. The VAS score did not decrease significantly seven months after therapy when compared to baseline (3.3 ± 3.6 vs. 7.3 ± 2.1; P = 0.011). However, the VAS score at two months (2.6 ± 2.9 vs. 7.3 ± 2.1; P = 0.007) and at four weeks (3.2 ± 2.8 vs. 7.3 ± 2.1; P = 0.007) significantly decreased when compared to baseline. The decrease in VAS scores was not persistent after cessation of the therapy.ConclusionsECSWT is an effective modality in relieving the pain intensity in patients with refractory chronic coccydynia for the early period after intervention.

The Efficacy of Extracorporeal Shock Wave Therapy for Chronic Coccydynia

“…The VAS score was assessed at the first, second, third, and fourth weeks after the initiation of the treatment and at 1 and 6 months after the last ESWT session. A significant decrease in the VAS score at 4 weeks ( p = 0.007) and 2 months ( p = 0.007) was observed; however, no significant decrease was detected at 7 months after the last ESWT session when compared with the baseline ( p = 0.011) [6]. In our study, we applied a minimum of four and a maximum of 10 sessions of ESWT until the VAS score decreased to ≤3.…”

“…It is associated with the fifth sacral and coccygeal nerve roots and the terminal sympathetic plexus. Coccydynia is defined as pain in the coccyx and/or coccygeal joints [1-5]; it is five times more common in women than in men [6]. Pain related to coccydynia is aggravated by sitting or prolonged sitting in the same position and cycling [1, 3, 7].…”

“…It is typically treated conservatively with modalities such as anti-inflammatory drugs, rest, use of a seating ring, hot water bath, physical therapy, massage, injection of a local anesthetic, or glucocorticoids to the coccyx, and manipulations [1, 6]. Coccygectomy is rarely recommended for patients who do not benefit from conservative treatment [1, 6, 9, 11].…”

Enhanced Spinal Therapy: Extracorporeal Shock Wave Therapy for the Spine

“…Coccydynia occurs due to inflammation of the coccyx, or its joint with the sacral vertebra, causing pain most commonly experienced upon moving from a seated to standing position [ 19 , 45 ]. The pathophysiology is most commonly attributed to coccygeal instability, subluxation, or trauma and it is five times more likely to occur in women [ 16 , 17 ]. The coccyx is associated with the fifth sacral and coccygeal nerve roots and the terminal sympathetic plexus [ 19 ].…”

“…Haghighat et al was the only investigator to report findings that potentially suggest the effects of ESWT began to reverse. In this study, VAS pain scores were lowest at two months post-treatment initiation and had increased at seven months follow up, however, not to pre-treatment levels and were still significantly lower [ 17 ]. A notable limitation of these studies is the lack of a control group, with the exception of the randomized control trial by Lin et al which compared ESWT to combined physical therapy with interferential current or shortwave diathermy treatment [ 16 ].…”