You have the option of medication - anti-inflammatory painkillers (NSAID's - non steroidal anti inflammatory drugs). These include things like ibuprofen, which can cause gastro-intestinal problems. Or stronger painkillers, such as opioid based medication but these can also have side effects. I have yet to find a successful analgesic.
Then we have the option of corticosteroid injections into/around the joint. These can be done under anaesthetic and can have anaesthetic introduced at the same time. This is sometimes done in combination with manipulation of the coccyx- manipulation under anaesthetic (MUA). Some surgeons feel this helps, although as the coccyx is a mobile joint anyway, I'm not convinced. The first MUA and injection I had helped, subsequent ones did not; and I gather this is often the case.
Some chiropractors, osteopaths and physiotherapists are also qualified to perform spinal manipulation.
There are further injections such as impar nerve blocks which some people have found effective at blocking the pain to that area.
Then of course we have the option of coccygectomy which although is apparently a straightforward quick procedure, is not without risks, and does not help everyone. NHS Choices state that 10-20% of people still suffer pain after the procedure. The rehabilitation is a lengthy one, and you need to understand this and be very committed to following post op advice.
After 3 months or more pain is termed 'persistent' or 'chronic'. The brain can continue sending pain signals even after the tissue is healed. Most things in the body will heal after 3-6 months. With chronic pain the nervous system becomes over sensitive. A Pain Consultant has told me that this is what is happening with me. He feels the actual coccyx may not now be the problem, but pain thresholds are lowered so that stimuli that would not normally cause pain, now do. Pain is prolonged and exaggerated. His suggestion has been impar nerve block. I've put this on hold for now.
Most recently I have seen a women's health physio who deals with coccydynia. Her method is to manipulate pressure points internally to relax and strengthen the pelvic floor that supports the coccyx, so that it can then work to hold the coccyx correctly. She agrees that chronic pain does not necessarily justify surgical intervention. As mentioned, the initial cause may not now be causing the chronic pain.
So I am trying the physio approach, and will give it up to eleven sessions. Failing that I will proceed with the impar nerve block. I am not prepared to seek surgical intervention.
Everyone with coccydynia has a different story to tell, has a different cause. As such, treatment should be individually tailored. Health Care Professionals should take a holistic approach, take a thorough history, and look at the whole person, not just the coccyx.
Over the coming weeks and months I'll look further into treatments, and share my journey.
I will appreciate any relevant comments and feedback. Thankyou.