Journal of Manipulative and Physiological Therapeutics
2009; 32: 287–293.
Wu CL, Yu KL, Chuang HY, Huang MH, Chen TW, Chen CH.
This study examines the potential usefulness of a novel thermal imaging technique in the assessment of local physiologic responses before and after conservative therapies for coccygodynia.
Patients with coccygodynia were selected on the basis of detailed history taking, clinical examination, and dynamic series radiography. They underwent therapeutic modalities consisting of 6 to 8 sessions of manual medicine treatments (massage of the levators followed by Maigne's manipulative technique) and external physiotherapy (short-wave diathermy) 3 times a week for 8 weeks. We performed the assessments with numeric pain rating scale (NPRS) and infrared thermography (IRT) before treatment and at 12 weeks.
A total of 53 patients (6 males and 47 females) ranging from 18 to 71 years of age and clinically diagnosed with coccygodynia received the full course of therapy and assessments. There were significant differences in both NPRS and surface temperature obtained by IRT in the 12-week follow-up (P < .05). The correlation between NPRS improvement and temperature decrement was significantly high (r = 0.67, P < .01).
The study shows that IRT can objectively show the decrement of surface temperatures correlating with changes in subjective pain intensity after treatment of coccygodynia. With the advantages of being painless, noninvasive, and easy to repeat, IRT appears to be useful as a quantifiable tool for monitoring the dynamics of the disease activity in coccygodynia.
1. Simpson J. Clinical lectures on the diseases of women. Lecture XVII. Coccygodynia, and diseases and deformities of the coccyx. Med Times Gaz 1859; 40:1-7.
2. Mazza L, Formento E, Fonda G. Anorectal and perineal pain: new pathophysiological hypothesis. Tech Coloproctol 2004; 8: 77-83.
3. Fogel GR, Cunningham PY, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg 2004; 12:49-54.
4. Arenas AJ, Gomez F, Salas R, et al. An evaluation of the application of infrared thermal imaging to the tele-diagnosis of sarcoptic mange in the Spanish ibex (Capra pyrenaica). Vet Parasitol 2002; 109:111-7.
5. Feng T, Zhao P, Liang G. Diagnostic significance of topical image of infrared thermograph on the patient with lumbar intervertebral disc herniation—a comparative study on 45 patients and 65 normal control. Zhongguo Zhong Xi Yi Jie He Za Zhi 1998; 18:527-30.
6. Brenner M, Braun C, Oster M, Gulko PS. Thermal signature analysis as a novel method for evaluating inflammatory arthritis activity. Ann Rheum Dis 2006; 65:306-11.
7. Devereaux MD, Parr GR, Thomas DP, Hazleman BL. Disease activity indexes in rheumatoid arthritis; a prospective, comparative study with thermography. Ann Rheum Dis 1985; 44: 434-7.
8. Varju G, Pieper CF, Renner JB, Kraus VB. Assessment of hand osteoarthritis: correlation between thermographic and radiographic methods. Rheumatology (Oxford) 2004; 43:915-9.
9. Ring EF, Dieppe PA, Bacon PA. The thermographic assessment of inflammation and anti-inflammatory drugs in osteoarthritis. Br J Clin Pract 1981; 35:263-4.
10. De Andres J, Chaves S. Coccygodynia: a proposal for an algorithm for treatment. J Pain 2003; 4:257-66.
11. Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005; 30: 1331-4.
12. Thiele GH. Coccygodynia: cause and treatment. Dis Colon Rectum 1963; 11:422-36.
13. Maigne R. Diagnosis and treatment of pain of vertebral origin: a manual medicine approach. Williams & Wilkins: Baltimore; 1996. p. P339-40.
14. Maigne JY, Tamalet B. Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in the sitting position. Clinical elements differentiating luxation, hypermobility, and normal mobility. Spine 1996; 21:2588-93.
15. Ramsey ML, Toohey JS, Neidre A, Stromberg LJ, Roberts DA. Coccygodynia: treatment. Orthopedics 2003; 26:403-5. 16. Wray CC, Easom S, Hoskinson J. Coccydynia. Aetiology and treatment. J Bone Joint Surg Br 1991; 73:335-8.
17. Maigne JY, Chatellier G, Faou ML, Archambeau M. The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine 2006; 31:621-7.
18. Maigne JY, Chatellier G. Comparison of three manual coccydynia treatments: a pilot study. Spine 2001; 26:479-83. 19. Goats GC. Continuous short-wave (radio-frequency) diathermy. Br J Sports Med 1989; 23:123-7.
20. Shields N, Gormley J, O'Hare N. Short-wave diathermy: current clinical and safety practices. Physiother Res Int 2002; 7: 191-202.
21. Fikackova H, Ekberg E. Can infrared thermography be a diagnostic tool for arthralgia of the temporomandibular joint? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98: 643-50.
22. So YT, Aminoff MJ, Olney RK. The role of thermography in the evaluation of lumbosacral radiculopathy. Neurology 1989; 39:1154-8.
23. Zaproudina N, Varmavuo V, Airaksinen O, Narhi M. Reproducibility of infrared thermography measurements in healthy individuals. Physiol Meas 2008; 29:515-24.
24. Huygen FJ, Niehof S, Klein J, Zijlstra FJ. Computer-assisted skin videothermography is a highly sensitive quality tool in the diagnosis and monitoring of complex regional pain syndrome type I. Eur J Appl Physiol 2004; 91:516-24.
25. Darton K, Black CM. The use of infra-red thermography in a rheumatology unit. Br J Rheumatol 1990; 29:291-2.
26. Grennan DM, Caygill L. Infra-red thermography in the assessment of sacro-iliac inflammation. Rheumatol Rehabil 1982; 21:81-7.
27. Mohl ND, Ohrbach RK, Crow HC, Gross AJ. Devices for the diagnosis and treatment of temporomandibular disorders. Part III: Thermography, ultrasound, electrical stimulation, and electromyographic biofeedback. J Prosthet Dent 1990; 63: 472-7.
28. Lund JP, Widmer CG, Feine JS. Validity of diagnostic and monitoring tests used for temporomandibular disorders. J Dent Res 1995; 74:1133-43.
29. Dieppe PA, Sathapatayavongs B, Jones HE, Bacon PA, Ring EF. Intra-articular steroids in osteoarthritis. Rheumatol Rehabil 1980; 19:212-7.
30. Chang TC, Hsiao YL, Liao SL. Application of digital infrared thermal imaging in determining inflammatory state and followup effect of methylprednisolone pulse therapy in patients with Graves' ophthalmopathy. Graefes Arch Clin Exp Ophthalmol 2008; 246:45-9.
31. Hakguder A, Birtane M, Gurcan S, Kokino S, Turan FN. Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermographic evaluation. Lasers Surg Med 2003; 33:339-43.
32. Albert SM, Glickman M, Kallish M. Thermography in orthopedics. Ann N Y Acad Sci 1964; 121:157-70.
33. Sherman RA, Barja RH, Bruno GM. Thermographic correlates of chronic pain: analysis of 125 patients incorporating evaluations by a blind panel. Arch Phys Med Rehabil 1987; 68:273-9.
34. Davoudi N, Afsharzadeh P, Mohammadalizadeh S, Haghdoost AA. A comparison of patients' and nurses' assessments of pain intensity in patients with coronary artery disease. Int J Nurs Pract 2008; 14:347-56.
35. Ilowite NT, Walco GA, Pochaczevsky R. Assessment of pain in patients with juvenile rheumatoid arthritis: relation between pain intensity and degree of joint inflammation. Ann Rheum Dis 1992; 51:343-6.
36. Pappalardo A, di Girolamo F, Brignone G, et al. Telethermography in the diagnosis of lumbo-sciatica syndromes. Clin Ter 1992; 141:193-7.