Landmark-Guided Dextrose Prolotherapy for Coccydynia: A Retrospective Study

Evaluation of the Effectiveness of Landmark-Guided (Blind) Dextrose Prolotherapy on Pain Severity and Functional Status in Patients With Coccydynia: A Retrospective Study

Coccydynia is a musculoskeletal pain condition that can lead to chronic pain and functional impairment, significantly affecting quality of life. Although conservative treatment is effective in many cases, the number of patients with refractory symptoms appears to be increasing, highlighting the need for effective and accessible treatment options.

Prolotherapy is a regenerative injection therapy that aims to stimulate tissue healing and reduce pain through the modulation of nociceptive signaling, most commonly using dextrose solutions.

This retrospective study aims to evaluate the effectiveness of landmark-guided (blind) dextrose prolotherapy in reducing pain and improving functional status in patients with mechanical or idiopathic coccydynia. The study includes patients who underwent prolotherapy to coccygeal ligaments between January 1, 2024, and June 1, 2025, with a treatment protocol consisting of 3-6 sessions administered at 3-week intervals using a 15% dextrose solution.

Study Overview

• Status: Completed
• Conditions: Coccydynia
• Intervention / Treatment: Procedure: Dextrose prolotherapy

Detailed Description

Coccydynia is a musculoskeletal pain condition characterized by pain localized to the coccygeal region, often leading to chronic pain and functional impairment that negatively affects quality of life. Although conservative treatment is effective in many patients, a growing number of cases remain refractory, highlighting the need for alternative therapeutic approaches.

Prolotherapy is a regenerative injection technique increasingly used in chronic musculoskeletal pain conditions. It aims to stimulate tissue repair and modulate nociceptive signaling through the administration of proliferant solutions, most commonly hypertonic dextrose. By inducing a controlled inflammatory response, prolotherapy is thought to promote fibroblast activity, collagen synthesis, and strengthening of ligamentous structures.

This retrospective cohort study aims to evaluate the effectiveness of landmark-guided (blind) dextrose prolotherapy in reducing pain severity and improving functional status in patients with mechanical or idiopathic coccydynia. The study includes patients who presented to the Physical Medicine and Rehabilitation Clinic of Gaziosmanpasa Training and Research Hospital between January 1, 2024, and June 1, 2025, with coccydynia persisting for at least 3 months and refractory to conservative treatment.

Eligible patients received prolotherapy injections targeting the coccygeal ligaments using anatomical reference points without ultrasound guidance. A 15% dextrose solution was administered in 3 to 6 sessions at 3-week intervals according to a standardized treatment protocol.

Pain severity and functional status were assessed using the Visual Analog Scale (VAS) and the Dallas Pain Questionnaire (DPQ), respectively. Outcome measures were evaluated at baseline (pre-treatment) and at follow-up after completion of the treatment protocol.

A minimum sample size of 30 patients was determined, and a total of 50 patients were included in the study.

• Study Type: Observational
• Enrollment (Actual): 50

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Health Sciences University Gaziosmanpaşa Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, 34255

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of patients aged 18 to 75 years diagnosed with mechanical or idiopathic coccydynia, with symptoms persisting for at least 3 months and refractory to conservative treatment, who underwent landmark-guided (blind) dextrose prolotherapy at the Physical Medicine and Rehabilitation Clinic of Gaziosmanpasa Training and Research Hospital between January 1, 2024, and June 1, 2025.

Description

Inclusion Criteria:

• Age between 18 and 75 years
• Diagnosis of mechanical or idiopathic coccydynia
• Pain persisting for at least 3 months
• Refractory to conservative treatment

Exclusion Criteria:

• Pregnancy
• Allergy to the proliferant solution
• Active infection
• Use of anticoagulant medications
• Presence of malignancy
• Local abscess
• Documented hemorrhagic diathesis
• Certain types of septic arthritis
• Parafunctional habits

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Landmark-Guided Dextrose Prolotherapy; This cohort includes patients with mechanical or idiopathic coccydynia who underwent landmark-guided (blind) dextrose prolotherapy using a 15% dextrose solution. Injections were performed to the coccygeal ligamentous structures based on anatomical reference points without ultrasound guidance.

Procedure: Dextrose prolotherapy; Landmark-guided (blind) prolotherapy was performed using a 15% dextrose solution under sterile conditions. The procedure was carried out based on anatomical reference points without ultrasound guidance. The coccygeal and sacrococcygeal ligamentous structures were targeted, and injections were administered to 3-4 periosteal insertion points using a 27G needle. A maximum of 0.5 mL was injected per site, with a total volume not exceeding 2-2.5 mL per session. The treatment protocol consisted of 3 to 6 sessions performed at 3-week intervals.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Scale (VAS)	Primary Outcome Measure Visual Analog Scale for Pain (VAS): Change in pain intensity assessed using the Visual Analog Scale (VAS).The VAS is a 10-cm horizontal scale ranging from 0 (no pain) to 10 (worst imaginable pain).Higher scores indicate greater pain intensity, and a reduction in VAS score represents clinical improvement.	Baseline and 1 month after completion of treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dallas Pain Questionnaire (DPQ)	The Dallas Pain Questionnaire (DPQ) is a validated instrument that evaluates the impact of chronic pain on functional status across four domains: daily activities, work and leisure activities, anxiety/depression, and social interest. Scores range from 0 to 100, with higher scores indicating greater functional limitation and a higher degree of pain-related impairment, whereas lower scores reflect better functional capacity and lower levels of impairment.	Baseline and 1 month after completion of treatment

Collaborators and Investigators

• Sponsor: Gaziosmanpasa Research and Education Hospital
• Investigators: Study Chair: Merve Dikici Yagli, Gaziosmanpasa Educational and Training Hospital

Publications and helpful links

General Publications

• Assiri K, Alqarni A, Almubarak H, Mohammed Kaleem S, Alassiri S, Baig FAH, Muhammed A, Kota MZ, Dawasaz AA, Alqahtani AM, Assiri HA, Arem SA, Abubaker Abbas Ali S, Luqman Mannakandath M. Efficacy of Prolotherapy for Temporomandibular Joint Dysfunction: An Interventional Clinical Study. Med Sci Monit. 2025 May 14;31:e946650. doi: 10.12659/MSM.946650.
• Mociu SI, Nedelcu AD, Lupu AA, Uzun AB, Iliescu DM, Ionescu EV, Iliescu MG. Prolotherapy as a Regenerative Treatment in the Management of Chronic Low Back Pain: A Systematic Review. Medicina (Kaunas). 2025 Sep 2;61(9):1588. doi: 10.3390/medicina61091588.
• Benditz A, Thoma R. Coccygodynia-Diagnosis and Treatment. Dtsch Arztebl Int. 2025 Nov 14;122(23):638-644. doi: 10.3238/arztebl.m2025.0154.
• Khan SA, Kumar A, Varshney MK, Trikha V, Yadav CS. Dextrose prolotherapy for recalcitrant coccygodynia. J Orthop Surg (Hong Kong). 2008 Apr;16(1):27-9. doi: 10.1177/230949900801600107.

Study record dates

Study Major Dates

• Study Start (Actual): January 15, 2026
• Primary Completion (Actual): March 15, 2026
• Study Completion (Actual): March 15, 2026

Study Registration Dates

• First Submitted: April 27, 2026
• First Submitted That Met QC Criteria: April 27, 2026
• First Posted (Actual): May 4, 2026

Study Record Updates

• Last Update Posted (Actual): May 4, 2026
• Last Update Submitted That Met QC Criteria: April 27, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Coccydynia; Dextrose Prolotherapy; Landmark-Guided Injection
• Other Study ID Numbers: 01 (Miami VAHS)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No