Archives of Physical Medicine and Rehabilitation
September 2004, Volume 85, Number 9. pe38 to pe38
Chiwai E. Chan, DO (Stanford Interventional Spine Center, Palo Alto, California); Raj Mitra, MD; Douglas G. Chang, MD, PhD
Tertiary care academic medical center.
A 39-year-old woman with coccydynia.
The patient had had a skiing accident more than one year before presentation and experienced worsening of coccydynia. No evidence of fractures or subluxation was noted on plain films in the lumbosacral spine. Physical examination revealed marked tenderness over the coccyx with palpation. 5% lidocaine (Lidoderm) patches were prescribed and she was advised to use it 12h on and 12h off. She ran out of patches after a month. During the following 11 days before a scheduled steroid injection, her pain was back to baseline without the patch. She then received a coccygeal steroid injection.
The numeric pain score before and after Lidoderm patch was 10/10 and 5/10, respectively. She reported that the patch provided significant pain relief. Her ability to perform daily activities and physical mobility also improved. There were no unfavorable side effects. Her pain returned to 10/10 without the patch. After the steroid injection, her numeric pain rating was 4/10. At 21 days post-injection, she continues to use the Lidoderm patch and her numeric pain score remains at 4/10.
The Lidoderm patch is currently approved by the US Food and Drug Administration for postherpetic neuralgia. There are no published studies on use of the Lidoderm patch for coccydynia. The Lidoderm patch provided similar pain relief for coccydynia compared with corticosteroid injection in this patient.
Conservative medical management for coccydynia is limited primarily to nonsteroidal anti-inflammatory drugs (NSAIDs) and injections of local anesthetics or corticosteroids. Lidoderm patches may provide pain relief for coccydynia as a monotherapy or in combination with NSAIDs and/or corticosteroid injections. Further studies are needed to evaluate the effectiveness of the Lidoderm patch for coccydynia.