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Non-neurodestructive ganglion impar blocks for coccydynia and related disorders: a systematic review and meta-analysis
  1. David S Jevotovsky1,
  2. Harman Chopra2,
  3. Daniel J Pak3,
  4. Eric A Grin1,
  5. Adhith Palla1,
  6. Shravani Durbhakula4,
  7. Sidharth Sahni1,
  8. Tariq AlFarra5,
  9. Mustafa Y Broachwala6,
  10. Anuj Shah7,
  11. Richard Lau1,
  12. Alexander Shustorovich8,
  13. Michael Flamm1,
  14. Melissa Murphy9,
  15. Timothy Deer10,
  16. Amitabh Gulati11 and
  17. Vwaire Orhurhu12
  1. 1Physical Medicine & Rehabilitation, New York University School of Medicine, New York, NY, USA
  2. 2Physical Medicine & Rehabilitation, Johns Hopkins Medicine, Baltimore, MD, USA
  3. 3Pain Medicine Division, University of Texas at Houston , Houston, TX, USA
  4. 4Anesthesiology, Pain Medicine Division, Vanderbilt University School of Medicine, Nashville, TN, USA
  5. 5Interventional Pain, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  6. 6Pain Medicine, University of California San Diego, San Diego, California, USA
  7. 7Pain Medicine, Weill Cornell Medicine , New York, NY, USA
  8. 8Physical Medicine & Rehabilitation, Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
  9. 9North Texas Orthopedics and Spine Center, Grapevine, TX, USA
  10. 10Spine and Nerve Center of the Virginias, West Virginia University—Health Sciences Campus, Morgantown, WV, USA
  11. 11Memorial Sloan Kettering Cancer Center, New York, NY, USA
  12. 12University of Pittsburgh Medical Center, Williamsport, PA, USA
  1. Correspondence to Dr Harman Chopra; drharmanchopra{at}gmail.com

Abstract

Background/Importance Chronic coccydynia is a challenging condition to manage. Conflicting evidence exists regarding the role of the ganglion impar in coccygeal nociception. When conservative treatments fail, minimally invasive interventions at the ganglion impar may be effective in providing relief.

Objectives To evaluate the effectiveness and safety of ganglion impar blocks (GIBs) for the management of chronic coccydynia.

Evidence review A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through a comprehensive literature search of PubMed, Embase Classic+ Embase, CINAHL and the Web of Science in February 2024. Data on patient characteristics, intervention details, pain outcomes (measured by Visual Analog Scale and Numerical Pain Rating Scale) and adverse events were extracted. Meta-analysis was performed using standardized mean differences (SMDs) on scale of 0 to 10.

Findings Seventeen studies described 625 coccydynia patients treated with GIB. All studies reported some level of improvement of pain after GIB. The meta-analysis included 11 studies totaling 391 patients with a baseline pain score of 7.93 (7.81 to 8.04 95% CI). GIBs were effective in reducing coccygeal pain at short-term (up to 3 months), intermediate-term (3–6 months) and long-term (greater than 6 months) follow-up. SMDs were −2.73 (95% CI −3.45 to −2.01), −3.22 (95% CI −2.82 to −1.45), −1.86 (95% CI −2.58 to −1.15) at 3 months, 3–6 months and >6 months, respectively. No serious adverse events were noted. Grading of Recommendations Assessment, Development and Evaluation assessment indicated ‘very low’ certainty of evidence across all outcomes.

Conclusions Non-neurodestructive GIB may be a safe and potentially effective treatment option for patients with chronic, refractory coccydynia.

PROSPERO registration number CRD42024506056.

  • Analgesia
  • Nerve Block
  • Outcome Assessment, Health Care
  • Pain Management

https://doi.org/10.1136/rapm-2024-106055

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    Footnotes

    • X @danieljpak, @ShravaniD_MD, @doctdeer

    • Contributors All authors contributed significantly to the production of this manuscript. DSJ, AP, EAG, SS: initial drafting, article review and data extraction. HC: conceptualization, review and editing, data analysis. DJP, SD, MYB, AS, TA, AS, RL, MF, TD, MM, AG: review and editing. VO: data analysis, review and editing, guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.