Pain
Cole T. Bridges, DO
Resident Physician
Yale New Haven Health
New Haven, Connecticut, United States
Avish S. Persaud, MD
Resident doctor
Yale New Haven Health
Rochester Hills, Michigan, United States
Schan Lartigue, MD
Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States
Charles A. Odonkor, MD, MA, FAAPMR
Assistant Professor of Orthopedics & Rehabilitation
Yale University School of Medicine
NEW HAVEN, Connecticut, United States
Cole T. Bridges, DO
Yale New Haven Health
New Haven, Connecticut, United States
A 37-year-old woman with an 18-month history of chronic coccydynia presented one week after a fall onto her sacrococcygeal region. She reported severe midline sacrococcygeal pain (10/10) worsened by sitting, ambulation, and sit-to-stand transitions, which markedly impaired occupational, social, and daily function. Prior treatments, including NSAIDs, topical agents, pelvic floor physical therapy, peri-coccygeal injections, and two fluoroscopy-guided ganglion impar blocks, provided only transient benefit. She declined surgical management with coccygectomy. On examination, pain was reproducible with palpation of the distal coccyx and bilateral parasacral regions. Radiographs revealed possible posterior subluxation of the coccyx. Given persistent symptoms, she underwent a 60-day peripheral nerve stimulation (PNS) trial targeting bilateral S3 nerve roots (middle cluneal nerve distribution). At therapy completion, the device was explanted. She subsequently reported complete resolution of coccygeal pain, with restored sitting tolerance, a return to daily activities, and an improved overall quality of life.
Discussions: Chronic coccydynia is a debilitating condition with limited durable treatment options. Standard management strategies progress from conservative therapies to corticosteroid injections and, for refractory cases, coccygectomy, which carries variable outcomes and surgical risks. Neuromodulation with temporary PNS offers a minimally invasive alternative by modulating aberrant nociceptive signaling. To our knowledge, this is the first reported case of PNS achieving complete resolution of refractory coccydynia. The magnitude of functional recovery underscores the potential of PNS to improve quality of life. This case highlights PNS as a novel and effective intervention in patients who are poor candidates for or decline coccygectomy.
Conclusions: Temporary PNS is a safe, minimally invasive, and effective therapeutic option for refractory chronic coccydynia and potentially expands rehabilitative interventions for this condition. This report demonstrates both clinical novelty and functional impact, supporting further investigation of neuromodulation as an alternative to surgery for sacrococcygeal pain syndromes.
