Tailbone pain

Q: I have been suffering from intense pain in my coccyx for several years. The pain started after a bad epidural and the subsequent therapeutic blood patch, but became infinitely worse after back surgery four years ago.

I have sought help from numerous consultants and general practitioners, but have been told that the coccyx is still a mystery. I have also seen two osteopaths in recent years, but both of them added to the pain, especially the second one, whom I consulted 15 months ago.

Apart from the unbearable pain, there is also a sensation of intense heat, like a red-hot poker in the rectum. Needless to say, my rectum has suffered as a result – and, apparently, nothing can be done about that either.

Acupuncture has not helped and painkillers do not reach the area. I am desperate – for years now, the pain has woken me up in the early hours of the morning so I get very little sleep.

I have never had the coccyx X-rayed or scanned, and I am wondering if this should be my next step. – E.M. Stacey, Bedford

A: Given the persistence and severity of your coccydynia (coccyx pain), it may be wise to go for a thorough examination, including imaging diagnostic tests such as X-rays or an MRI scan. This is to make sure that the pain is indeed coming from your coccyx, and not from something else in the area.

Several things can cause coccyx pain. It could arise from an unstable coccyx – one that moves about too much when you sit down – as a result of trauma such as a fall, childbirth or car accident, or from a weakening of the joint. It could also be due to: a misaligned coccyx; a rigid, non-flexible coccyx; a coccyx that is too long; the growth of bony spurs on the coccyx; or damaged nerves in the region. An X-ray or MRI scan will rule out an infection or tumour. Finally, there are cases, such as yours, where the pain follows medical treatment such as an epidural or back surgery.

As your pain followed a bad epidural, WDDTY panellist Dr Harald Gaier suggests that the needle may have damaged the cartilage between the various segments that make up the tailbone. And, in this case, manipulation would indeed do little to resolve the problem.

However, taking into account your experiencing of intense heat in the anal region, the problem may not lie with the coccyx, but with the neighbouring sacral area. The intense heat may be a referred sensation from the second sacral (S2) nerve. I would use a special traction method that involves the sacroiliac joints to alleviate the problem, says Dr Gaier.

The treatment for your coccydynia will depend on the cause. Unless you know what this is, it is difficult to advise you on what the appropriate treatment would be.

But, in the meantime, there are various pain-relief therapies besides acupuncture and osteopathy that you may wish to try to make your life more bearable.

* Massage is a recognized method of pain management that also helps to boost the immune system, and reduce anxiety and stress. It is believed that, by massaging the skin, messages are sent up the spine, stimulating the vagus nerve in the brain. Levels of the stress hormone cortisol are then lowered while those of the feel-good hormone serotonin are raised.

In a study comparing massage, acupuncture and self-care education for persistent back pain, massage proved superior to the two other therapies in reducing symptoms and disability. In addition, the massage group used the least medications and had the lowest costs of subsequent care (Arch Intern Med, 2001; 161: 1081-8). Massage therapy can also been ease fibromyalgia, and was more effective than relaxation therapy in helping people improve their sleep (J Clin Rheumatol, 2002; 8: 72-6).

* Magnetic therapy is better known for managing pain rather than curing it. The theory behind this therapy is that the magnetic fields produced by magnets (or devices that generate an electromagnetic current) can penetrate the body, and improve the functioning of individual cells, the nervous system and various organs.

In patients with knee pain due to chronic osteoarthritis, exposure to a low-frequency magnetic field for six minutes, in eight sessions, produced significant pain relief in 46 per cent of patients, compared with 8 per cent of those who received dummy magnetic therapy (Altern Ther Health Med, 2001; 7: 54-64, 66-9).

In yet another study, also involving patients with osteoarthritis, hip and knee pain were both reduced when the patients wore a standard-strength, static, bipolar magnetic bracelet for 12 weeks (BMJ, 2004; 329: 1450-4).

* Take 1-2 g/day of powdered ginger. Dubbed ‘nature’s aspirin’, as a potent antirheumatoid/anti-inflammatory, ginger is commonly used in traditional Chinese and Ayurvedic medicine to help patients with rheumatoid disorders (any painful condition of the joints/muscles/connective tissues).

* Boost your B vitamins. Vitamin B6 (pyridoxine) is essential for the manufacture of neurotransmitters such as serotonin, one of the body’s own painkillers. The recommended supplement dose is 50 mg once or twice a day. It is found in a wide variety of foods, including cereals, beans, meat, poultry, fish, bananas and vegetables – in particular, potatoes. Make sure you also have a sufficient intake of vitamin B2 (riboflavin), as it helps promote the uptake of vitamin B6 as well as other B vitamins. Foods rich in riboflavin include meat, cheese, egg yolk, yoghurt, milk and poultry. Other sources are green leafy vegetables, broccoli, soy products and enriched bread. It is recommended that riboflavin be taken with an equivalent amount of vitamin B6.

* Eat high-fibre foods and drink plenty of fluids. This will soften stools and avoid constipation. Consume plenty of fresh fruits and vegetables, cooked wholegrain cereals with added bran, and foods containing wholegrains such as amaranth, quinoa, oat bran and rye. Make sure that you drink 8-10 glasses of fluid every day. Tea and coffee can be effective laxatives but, as caffeine can contribute to constipation, it should not be included in your daily count of fluid intake.

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Written by What Doctors Don't Tell You

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