Targeting dual pathways in refractory coccydynia: A comparative study of ganglion impar block alone versus combined with pericoccygeal injection

Objectives: Coccydynia is a complex and often refractory pain condition involving both sympathetic and somatic components. While ganglion impar block (GIB) is a well-established interventional technique for cases unresponsive to conservative treatment, pericoccygeal injection may offer additional benefits by targeting peripheral sensitization and anococcygeal nerve-mediated pain. This study aimed to evaluate and compare the clinical effectiveness of GIB alone versus GIB combined with pericoccygeal injection in patients with refractory coccydynia.
Methods: This retrospective cohort study included 60 patients aged 18–65 years treated at a tertiary pain clinic between June 2022 and June 2024. Patients received either GIB alone or GIB combined with pericoccygeal injection in a single session under fluoroscopic guidance. Pain severity and functional outcomes were assessed using the Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), and Paris Functional Coccydynia Impact Questionnaire (PFCIQ) before the procedure and at 1 and 3 months post-intervention.
Results: Both groups demonstrated significant improvements in NRS-11, ODI, and PFCIQ scores at 1 and 3 months compared to baseline (p<0.001). The combination therapy group showed significantly greater reductions in NRS-11 and ODI scores at 1 month (p=0.043 and p=0.036, respectively), and in ODI scores at 3 months (p=0.04). Analgesic use declined prominently in both groups, and no major complications were reported.
Conclusion: A single-session combination of GIB and pericoccygeal injection appears to offer superior short-term pain relief and func-tional improvement compared to GIB alone in refractory coccydynia. Further prospective studies are needed.

Keywords: Coccydynia, fluoroscopy, pain management, somatic pain, spinal injections, sympathetic pain.