Ultrasound Guided Dextrose Prolotherapy for Persistent Coccygeal Pain: A Case Series and Review of Literature

Coccydynia is a common condition that has been difficult to treat effectively with conventional pain relief methods. There has been previous research demonstrating safety and efficacy of prolotherapy to treat coccydynia. Many of the original descriptions were performed utilizing landmark or palpation guided techniques. However, there is evidence that imaging guidance improves accuracy of injections for axial and appendicular injections. We describe the use of ultrasound guidance for prolotherapy to accurately guide treatment into the coccyx in three patients leading to pain relief, improvement of motor function, and decrease in analgesic usage after treatment. Coccydynia, or pain in the coccyx, is marked by significant pain in and around the coccyx that does not radiate, and is made worse by sitting or by standing up from the sitting position [1]. It may impair the patient’s ability to perform activities of daily living (ADLs) such as sitting, standing, walking, and defecation. Coccydynia is most commonly caused by direct trauma to the coccyx such as falling. The trauma leads to inflammation and edema with possible subluxation or abnormal hypermobility of the coccyx [2]. The differential diagnosis of coccygeal pain includes other conditions such as bursitis of the adventitia at the coccygeal tip, traumatic arthritis of the sacrococcygeal joint, non-united fractures, irregular tumors or cysts on the coccyx, lesions to the surrounding areas, arachnoiditis, or precoccygeal calcific tendinitis [3]. Careful workup is needed to rule out these underlying conditions prior to treatment for pain. Various abnormal radiographic findings associated with coccydynia have been described and may be detectable within three months from onset of pain to, such as coccygeal retroversion with spicules, scoliotic deformity, or coccygeal anteversion, anterior or posterior subluxation, hypermobility. However, up to 30% of cases may have no identifiable radiographic abnormalities [4-6]. Citation: Chen YT, Brundage C, Griffin SC, Murphy IC, Luigi AJD (2013) Ultrasound Guided Dextrose Prolotherapy for Persistent Coccygeal Pain: A Case Series and Review of Literature. Altern Integ Med 2: 142. doi:10.4172/2327-5162.1000142