Health Technology Brief

supporting sound, evidence-based decision making

Ganglion Impar Block or Radiofrequency Thermocoagulation for the Treatment of Chronic Coccydynia

December 4, 2018

Health Problem: Coccydynia is an uncommon painful condition in the tailbone area (coccyx). While a majority of cases resolve with or without conservative management within months, a small group of patients find coccydynia painful and debilitating.

Technology Description: Therapeutic intervention to the ganglion impar may be performed with a ganglion impar block (GIB) or radiofrequency thermocoagulation (RFT). A GIB is typically performed by fluoroscopically injecting bupivacaine, saline, and methylprednisolone. Ganglion impar RFT is performed by fluoroscopically positioning a radiofrequency needle and ablating the nerve at 80°C for 80 to 90 seconds.

Controversy: Coccydynia is a rare condition, with a majority of patients responding to conservative management. Controversies surrounding GIB and RFT of the ganglion impar include whether the interventions are efficacious and safe for the treatment of chronic coccydynia, the durability of effect, and cost-effectiveness. In addition, there is uncertainty revolving around appropriate patient selection criteria for the use of GIB and RFT for the treatment of chronic coccydynia.

Key Questions:

  • Is GIB effective in treating chronic coccydynia?
  • Is RFT of the ganglion impar effective in treating chronic coccydynia?
  • How does GIB compare with other treatments for chronic coccydynia?
  • How does RFT of the ganglion impar compare with other treatments for chronic coccydynia?
  • Is GIB safe?
  • Is RFT of the ganglion impar safe?
  • Have definitive patient selection criteria been identified for GIB or RFT of the ganglion impar for the treatment of chronic coccydynia?