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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sacral chordomas are rare, slow-growing tumours that are amenable to surgery, but unfortunately often diagnosed late. The aim of the study was to identify presenting symptoms, which may aid diagnosis and reduce the treatment time. Forty-four patients were identified with sacral chordoma between 1989 and 2006. Clinical and pathological records were reviewed retrospectively to elicit the symptoms recorded prior to diagnosis, duration of symptoms, surgical treatment, size of tumour and survival. Eleven patients were excluded, leaving 33 patients in the study group. Thirty-one patients had chordomas arising from the sacrum and two patients from the coccyx. The mean duration of symptoms prior to diagnosis was 120 weeks (2.3 years), with a median of length of 104 weeks (two years) and range of 26 to 416 weeks (0.5 to eight years). The mean maximum tumour size at resection was 8.3 cm, with a mean volume of 614 cm(3) (range 9-2,113 cm(3)). Pain, typically dull and worse with sitting, was the most common presenting symptom in 85% of patients. The classic symptoms of cauda equina (saddle anaesthesia, bladder or bowel dysfunction) occurred in 70% patients (23 patients). Sacral chordoma should be considered in cases of back pain with coccydynia, especially with neurological symptoms.
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PMID:Sacral chordoma: a diagnosis not to be sat on? 1720 49

No satisfactory therapy has yet been found to relieve many chronic pelviperineal pains such as Dyspareunia, Vulvodynia, Coccygodynia and other various pelvic pains, although these can be highly disruptive in everyday life. They may be brought on by an osteo-myo-fascial disorder, often undetected despite the possibility to effectively treat, this condition using manual medicine in the gynaecologist's office. A framed clinical examination protocol as well as a therapeutic one are offered in this novel approach still rarely implemented in gynaecology. Such treatment is documented in six typical clinical cases and a global study on 86 patients with disruptive chronic pelviperineal pain, showing 71% satisfactory results following two manual medicine sessions. These very encouraging results need to be confirmed on a larger scale in order to establish an appropriate teaching protocol.
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PMID:[Painful perineum in all its forms. Contribution of manual medicine and osteopathy. Clinical study]. 1861 97

Coccydynia is a term that refers to pain in the region of the coccyx. Most cases are associated with abnormal mobility of the coccyx which may trigger a chronic inflammatory process leading to degeneration of this structure. In some patients this instability may be detected on dynamic radiographs. Nonsurgical management remains the gold standard treatment for coccydynia, consisting of decreased sitting, seat cushioning, coccygeal massage, stretching, manipulation, local injection of steroids or anesthetics, and postural adjustments. Those patients who fail these conservative modalities may potentially benefit from coccygectomy. However, surgical intervention is typically reserved for patients with evidence of advanced coccygeal instability (e.g., subluxation or hypermobility) or spicule formation, as this population appears to exhibit the greatest improvement postoperatively.
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PMID:Coccydynia. 1946 9

A new technique for performing nerve blocks of the ganglion impar (ganglion Walther) is presented. These injections have been reported to relieve coccydynia (tailbone pain), as well as other malignant and nonmalignant pelvic pain syndromes. A variety of techniques have been previously described for blocking this sympathetic nerve ganglion, which is located in the retrorectal space just anterior to the upper coccygeal segments. Prior techniques have included approaches through the anococcygeal ligament, through the sacrococcygeal joint, and through intracoccygeal joint spaces. This article presents a new, paracoccygeal approach whereby the needle is inserted alongside the coccyx and the needle is guided through three discrete steps with a rotating or corkscrew trajectory. Compared with some of the previously published techniques, this paracoccygeal corkscrew approach has multiple potential benefits, including ease of fluoroscopic guidance using the lateral view, ability to easily use a stylet for the spinal needle, and use of a shorter, thinner needle. While no single technique works best for all patients and each technique has potential advantages and disadvantages, this new technique adds to the available options.
Pain Pract
PMID:Paracoccygeal corkscrew approach to ganglion impar injections for tailbone pain. 1950 Feb 74

This article presents a case of a 53-year-old woman who presented with intermittent, dull, poorly localized lower back and buttock pain. The pain worsened in a seated position or after long periods of standing. A T1-weighted magnetic resonance image (MRI) of the sacrum and coccyx revealed a well-demarcated intraosseous lesion with homogeneous low signal intensity, while T2-weighted MRIs demonstrated homogeneous high signal intensity. An excisional biopsy revealed benign notochord cell tumor. The biopsy proved to be effective, as it relieved the patient's coccydynia. Due to the rarity of intraosseous benign notochordal cell tumors, it is essential to document and review this type of tumor. Only 2 benign notochordal cell tumors involving the coccyx have been previously reported, both of which presented with the same clinical symptoms of chronic coccydynia as our patient, likely due to the location of the involved lesion. The other leading diagnosis in our patient was chordoma, a malignant and locally aggressive neoplasm that is important to consider and exclude. Although chordomas have been well characterized in the surgery, pathology, and radiology literature, the benign notochordal cell tumor is a relative newcomer.
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PMID:A rare case of intraosseous benign notochordal cell tumor of the coccyx. 1963 13

Coccygodynia (pain in the region of the coccyx) has many causes, but it may be posttraumatic beginning after a fracture or contusion. Pain is typically triggered by or occurs while sitting. Nonsurgical management, including cushions, nonsteroidal anti-inflammatory drugs, and corticosteroid injections, can be successful in up to 85% of patients. The objective of the study was to show that coccygectomy can be a successful surgical treatment for patients who fail nonoperative treatment. This study is a retrospective analysis of all patients who underwent a coccygectomy performed by one surgeon between the years 2002 and 2008. All patients were asked to complete an Oswestry low back pain disability questionnaire and a visual analog pain scale. The average Oswestry disability score was 25.75%. The average visual analog score was 3.4 cm. Four patients sustained a wound breakdown. The study concluded that for patients with conservative therapy-resistant coccygodynia, operative treatment with coccygectomy is a feasible management option.
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PMID:Coccygectomy for the treatment of therapy-resistant coccygodynia. 1984 40

Chronic coccydynia can be treated with a glucocorticoid injection into the pain-causing intercoccygeal disk. We report four cases of calcifications within intercoccygeal disks previously injected with cortivazol. In two patients, the calcifications probably caused additional pain. Prednisolone acetate should be preferred over cortivazol for intercoccygeal disk injections.
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PMID:Four cases of coccygeal disk calcification after cortivazol injection. 1994 26

Between 1993 and 2008, 41 patients underwent total coccygectomy for coccydynia which had failed to respond to six months of conservative management. Of these, 40 patients were available for clinical review and 39 completed a questionnaire giving their evaluation of the effect of the operation. Excellent or good results were obtained in 33 of the 41 patients, comprising 18 of the 21 patients with coccydynia due to trauma, five of the eight patients with symptoms following childbirth and ten of 12 idiopathic onset. In eight patients the results were moderate or poor, although none described worse pain after the operation. The only post-operative complication was superficial wound infection which occurred in five patients and which settled fully with antibiotic treatment. One patient required re-operation for excision of the distal cornua of the sacrum. Total coccygectomy offered satisfactory relief of pain in the majority of patients regardless of the cause of their symptoms.
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PMID:Coccygectomy: an effective treatment option for chronic coccydynia: retrospective results in 41 consecutive patients. 2013 Mar 16

The authors present their twenty-year experience with coccygectomy as described by Gardner in a group of 60 patients. The mean age was 36 years, the youngest patient was 11 years old and the oldest 63 years. The group was formed mostly by women (95 %). The authors evaluated in particular the subjective response to the operation, i. e. mitigation of pain, the etiology, persistence of complaints, period and type of ambulatory treatment and the postoperative course (i. e. healing of the surgical wound, type of after-treatment and convalescence period. In the described group of patients 53 reported complete regression of complaints, in seven patients the pain persisted in the sense that the scar was tender or the distal end of the sacrum was tender on pressure. Complaints which developed soon after operation, such as painful or impossible defecation, pain when sitting etc., receded relatively rapidly and in the majority disappeared spontaneously and completely. Their possible persistence can be successfully treated by injections of a local anaesthetic or in combination with corticosteroids, relief during burdening and selection of a suitable sitting position. Coccygectomy according to Gardner's method, if a careful technique is used, resolves the complaints of the majority of patients. Key words: coccygectomy according to Gardner, coccygodynia.
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PMID:[Twenty Years Experience with Gardner's Coccygectomy.]. 2047 May 46

Coccygodynia is painful condition localized in the region of the coccyx. In most cases a traumatic etiology is present. In the idiopathic form other causes such as infections and tumor have to be excluded. Coccygodynia can also be the result of pain referred from visceral structures due to conditions such as disorders of the rectum, the colon sigmoideum, and the urogenital system. In case of a traumatic etiology the diagnosis is made based on the typical medical history whereby the pain is provoked by prolonged sitting and cycling. Lateral images of the coccyx are always indicated. The same is true for manual examination of the coccyx. In case of absence of provocation of the coccygeal pain by prolonged sitting and manual examination neurological causes such as lumbar disc hernias are a possible reason for the coccygodynia. In the acute phase the first choice of treatment are NSAIDs. Treatment for patients with severe pain in the chronic phase consists of manual therapy and/or a local injection of local anesthetic and corticosteroid into the painful segment (2 C+). Other interventional treatments such as intradiscal injections, ganglion impar block, radiofrequency treatment and caudal block are advised only under study conditions (0). Coccygectomy is not recommended because of long-term moderate results and the chance of major complications.
Pain Pract
PMID:14. Coccygodynia. 2192 24


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