American Academy of Pain Medicine
24th Annual Meeting. 2008: Poster 144.
Nameer Haider, M.D., DABPM
Spinal & skeletal pain medicine, Utica, NY, USA and Rao Ali, MD, Montefiore Medical Center, NY, Bronx, NY, USA.
A 41-year-old woman presented with 3-year history of severe coccyx bone pain and sacrococcygeal ligament instability secondary to prolonged bed immobilization , status post multiple surgeries including hysterectomy, bowel resection, and open heart surgery. Patient was placed on a ventilator and remained in a coma for about a month prior to coccyx pain . The patient had been seen by multiple pain practitioners, physiatrist, gynecologist, psychiatrist and has tried pain relieving modalities, NSAID's, muscle relaxants, narcotics, anti- depressants and lidoderm patches without any significant relief. Patient received Caudal Epidural injections, multiple Ganglion Impar Blocks with and without radiofrequency lesioning (Inter-Coccygeal as well as Sacrococcygeal blocks), SI joint injection with only temporary pain relief. Eventually a trial of Spinal Cord Stimulation was performed. The numeric pain intensity was 9-10/10 on verbal analogue scale prior to stimulator implantation. One week after procedure, the pain was reduced to 5-6/10 and after few weeks it was completely resolved. The patient went to have permanent stimulation. Patient is following up on regular basis and since permanent implantation of Spinal Cord Stimulator, she had no complaint of coccyx pain. Further investigation is needed to determine the efficacy of spinal cord stimulation in Coccydynia.
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