Effects of Extracorporeal Shock Wave Therapy on Pain in Patients With Chronic Refractory Coccydynia: A Quasi-Experimental Study

Shila Haghighat, Mahboobeh Mashayekhi Asl, Shila Haghighat, Mahboobeh Mashayekhi Asl

Abstract

Background: Several nonsurgical and surgical treatment modalities are available for patients with chronic coccydynia, with controversial results. Extracorporeal shock wave therapy (ECSWT) is effective in the treatment of many musculoskeletal disorders; however, it has not been tested for chronic coccydynia.

Objectives: We performed the current study to determine the effects of ECSWT on pain in patients with chronic coccydynia.

Patients and methods: This quasi-interventional clinical study included 10 patients with chronic coccydynia without acute fracture. All the patients received ECSWT with a radial probe delivering 3,000 shock waves of 2 bar per session at 21 Hz frequency directed to the coccyx. Each patient received four sessions of ECSWT at one-week intervals. The pain severity was recorded according to the visual analog scale (VAS) at one, two, three, and four weeks after initiation of therapy. The VAS score was also evaluated at one and six months after ending the therapy.

Results: Most of the participants were women (90.0%), and the participants' mean age was 39.1 ± 9.1 (ranging from 28 to 52) years. The VAS score did not decrease significantly seven months after therapy when compared to baseline (3.3 ± 3.6 vs. 7.3 ± 2.1; P = 0.011). However, the VAS score at two months (2.6 ± 2.9 vs. 7.3 ± 2.1; P = 0.007) and at four weeks (3.2 ± 2.8 vs. 7.3 ± 2.1; P = 0.007) significantly decreased when compared to baseline. The decrease in VAS scores was not persistent after cessation of the therapy.

Conclusions: ECSWT is an effective modality in relieving the pain intensity in patients with refractory chronic coccydynia for the early period after intervention.

Keywords: Coccydynia; Extracorporeal Shock Wave Therapy (ECSWT); Pain; VAS Score.

Figures

Figure 1.. Trends in Changes of VAS…
Figure 1.. Trends in Changes of VAS Score in 10 Patients with Chronic Coccydynia Undergoing Extracorporeal Shock Wave Therapy

References

    1. Maigne JY, Pigeau I, Aguer N, Doursounian L, Chatellier G. Chronic coccydynia in adolescents. A series of 53 patients. Eur J Phys Rehabil Med. 2011;47(2):245–51.
    1. Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976). 2000;25(23):3072–9.
    1. Maigne JY, Rusakiewicz F, Diouf M. Postpartum coccydynia: a case series study of 57 women. Eur J Phys Rehabil Med. 2012;48(3):387–92.
    1. Nathan ST, Fisher BE, Roberts CS. Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br. 2010;92(12):1622–7. doi: 10.1302/0301-620X.92B12.25486.
    1. Karadimas EJ, Trypsiannis G, Giannoudis PV. Surgical treatment of coccygodynia: an analytic review of the literature. Eur Spine J. 2011;20(5):698–705. doi: 10.1007/s00586-010-1617-1.
    1. Woon JT, Maigne JY, Perumal V, Stringer MD. Magnetic resonance imaging morphology and morphometry of the coccyx in coccydynia. Spine (Phila Pa 1976). 2013;38(23):1437–45. doi: 10.1097/BRS.0b013e3182a45e07.
    1. Woon JT, Stringer MD. Clinical anatomy of the coccyx: A systematic review. Clin Anat. 2012;25(2):158–67. doi: 10.1002/ca.21216.
    1. Fogel GR, Cunningham P3, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12(1):49–54.
    1. Marinko LN, Pecci M. Clinical decision making for the evaluation and management of coccydynia: 2 case reports. J Orthop Sports Phys Ther. 2014;44(8):615–21. doi: 10.2519/jospt.2014.4850.
    1. Patijn J, Janssen M, Hayek S, Mekhail N, Van Zundert J, van Kleef M. 14. Coccygodynia. Pain Pract. 2010;10(6):554–9. doi: 10.1111/j.1533-2500.2010.00404.x.
    1. Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84–7.
    1. Scemama P, Shaparin N, Kaufman A, Dua S. Radiofrequency ablation within the first intercoccygeal disk for coccygodynia: a case report. Pain Pract. 2011;11(3):278–81. doi: 10.1111/j.1533-2500.2010.00423.x.
    1. Imani F. Using pulsed radiofrequency for chronic pain. Anesth Pain Med. 2012;1(3):155–6. doi: 10.5812/kowsar.22287523.4047.
    1. Imani F, Rahimzadeh P. Interventional pain management according to evidence-based medicine. Anesth Pain Med. 2012;1(4):235–6. doi: 10.5812/aapm.4514.
    1. Patel VB, Wasserman R, Imani F. Interventional Therapies for Chronic Low Back Pain: A Focused Review (Efficacy and Outcomes). Anesth Pain Med. 2015;5(4):29716. doi: 10.5812/aapm.29716.
    1. Sluijter ME, Imani F. Evolution and mode of action of pulsed radiofrequency. Anesth Pain Med. 2013;2(4):139–41. doi: 10.5812/aapm.10213.
    1. Antoniadis A, Ulrich NH, Senyurt H. Coccygectomy as a surgical option in the treatment of chronic traumatic coccygodynia: a single-center experience and literature review. Asian Spine J. 2014;8(6):705–10. doi: 10.4184/asj.2014.8.6.705.
    1. Haddad B, Prasad V, Khan W, Alam M, Tucker S. Favourable outcomes of coccygectomy for refractory coccygodynia. Ann R Coll Surg Engl. 2014;96(2):136–9. doi: 10.1308/003588414X13814021676675.
    1. Romeo P, Lavanga V, Pagani D, Sansone V. Extracorporeal shock wave therapy in musculoskeletal disorders: a review. Med Princ Pract. 2014;23(1):7–13. doi: 10.1159/000355472.
    1. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 2012;7:11. doi: 10.1186/1749-799X-7-11.
    1. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res. 2003;21(6):984–9. doi: 10.1016/S0736-0266(03)00104-9.
    1. Tepekoylu C, Wang FS, Kozaryn R, Albrecht-Schgoer K, Theurl M, Schaden W, et al. Shock wave treatment induces angiogenesis and mobilizes endogenous CD31/CD34-positive endothelial cells in a hindlimb ischemia model: implications for angiogenesis and vasculogenesis. J Thorac Cardiovasc Surg. 2013;146(4):971–8. doi: 10.1016/j.jtcvs.2013.01.017.
    1. Marwan Y, Husain W, Alhajii W, Mogawer M. Extracorporeal shock wave therapy relieved pain in patients with coccydynia: a report of two cases. Spine J. 2014;14(1):1–4. doi: 10.1016/j.spinee.2013.07.438.
    1. Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J. 2012;2(1):33–7.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe