Coccygeal nerve blocks are x-ray guided injections used to help in the diagnosis and treatment of chronic low back pain, specifically in the rectum and the tailbone (coccyx). The coccygeal nerves send pain from the tailbone to the spinal cord and eventually the brain.
What conditions are treated with a Coccygeal Nerve Block?
The tailbone or coccyx is located near the base of the spine, underneath the sacrum. The tailbone or coccyx mainly functions as a structure that bears the body’s weight as well as a point of attachment for many muscles, tendons, ligaments, and nerves.
Coccyx pain, which is referred to as coccydynia, is typically described by individuals as throbbing pain in the higher portions of the rectum. The pain is the result of degenerating bones or fractures at the base of the spine. Having poor posture or sitting for extended periods of time, places excess pressure on the coccyx and this can sometimes develop into coccydynia.
Patients with coccygeal nerve related pain can have difficulty sitting for long periods of time. Typically pain starts near the tailbone and the rectum. However, the pain may extend into the buttocks, lower back, and even the legs.
How is the procedure performed?
Our team will help position you to make sure the procedure can be completed with the least amount of discomfort for you. The skin is cleansed with a sterilizing solution (chlorhexidine) and a sterile drape is placed. A local anesthetic medication typically (lidocaine) is given to numb the skin. Next the needle(s) is directed to the desired location. A local anesthetic for numbing and /or steroids for reducing inflammation are then injected. During the entire procedure you will be constantly monitored by the physician. After the injection a small bandage is placed on your skin. You will be given time after the procedure to make sure you feel good and are not having side-effects before leaving the clinic.
What medication is injected?
The injection includes a combination of anesthetic (lidocaine or bupivacaine) and sometimes steroid (cortisone, Kenalog or dexamethasone).
Does the procedure hurt?
The procedure is typically well tolerated. A localized burning sensation from the anesthetic is commonly felt and is usually the most uncomfortable part of the process. During the procedure a pressure sensation is often experienced this typically resolves within a few minutes. Minor soreness for a week after the procedure is normal.
How long does the procedure take?
The procedure typically takes about 15 minutes to perform. Please plan on being at the clinic for about 1 hour to allow for pre- and post-procedural safety protocols.
How quickly will I get relief?
The nerve block will result in quick relief. Our clinical nurse should call you on the following day to check on you. Future planned injections can be scheduled at that time.
How long can I expect the relief to last?
Every patient is different, some patients get a day of relief. Sometimes these injections can provide more than 6 months of relief.
How often can the procedure be repeated?
Depending on results and providers discretion the injections may be repeated every 1-3 months.
Can I have the injection if I have diabetes?
Yes. It is important to control your blood sugar before and after the injection. Diabetic patients may experience a small temporary increase in blood sugar lasting no more than 2-3 days.
What are the risks and side effects?
Risks and side effects are minimal and serious complications are rare. We take every precaution to ensure safety. Potential risks may include but are not limited to: vasovagal response (passing out), new or increased pain, infection, bleeding, permanent skin changes, allergic or unexpected drug reaction with minor or major consequences, and unintended nerve injury.
Please let us know if you have an active infection, are using antibiotics, or are using blood thinners.
Should I take my normal medications as scheduled?
Yes. Continue prescribed medications as you typically take prior to procedure.
What if I am on a blood thinner or Aspirin?
Anticoagulation is often stopped for a short period of time prior to injection. Please speak with your primary physician if you take blood thinners to make sure that you can safely stop taking these medications.
Do I need a driver?
Yes. For your safety we require a driver to take you home.
Can I eat the day of the procedure?
It depends on the location. We recommend eating a light meal if the injection is done in our clinic. If the procedure is done at the surgery center, then you must fast for at least 8 hours prior to the procedure.
Can I get sedation or anesthesia?
Most patients do well without sedation. Light sedation with oral medications is sometimes provided at the physician’s discretion.
What if I am pregnant?
There are serious potential risks to an unborn fetus when exposed to imaging studies, including x-ray and fluoroscopy. If there is any chance you may be pregnant, please postpone this procedure until it can be confirmed that you are not pregnant as it is not safe to do during pregnancy.
What should I wear?
We recommend light loose-fitting clothes. Sometimes we will ask you to change into a gown.
When can I drive after the procedure?
We recommend resuming driving the next day.
What can I do if I am sore or have pain after the procedure?
Ice packs can be applied to the area for 20 minutes per hour. Over the counter Tylenol and Motrin can be used to aid with any discomfort.
What are my restrictions after the procedure?
Typically, you may resume light activities on the same day following your procedure. Physical therapy can be re-started within 24 hours. We recommend returning to work the day after the procedure.
When can I shower?
Showering the day of the procedure is allowed. For 24 hours you are asked to refrain from submerging or swimming in water. Keep the bandage on for one day.
When do I come back for a follow-up visit?
We follow-up with all of our patients after their procedures. We typically see patients back in 2-4 weeks.