Nurse who suffers chronic tailbone pain

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I am a Registered Nurse who has suffered with tailbone pain for over 8 years. Like all chronic pain, it is essential that sufferers get the correct support, diagnosis and treatment appropriate for them as an individual. This blog follows my journey with chronic pain, it expresses my personal opinions and thoughts. It is not intended as a replacement for advice or treatment from your normal Healthcare Provider.

Saturday, 28 February 2015

Some of my thoughts


Coccyx pain and sacral discomfort
The thoughts below are my thoughts on this condition. These are some of the points I feel are important, and some of the issues I feel should be looked at. I am evolving this over time, and hope to present it to GP's at some point, but not sure how to approach it at the moment. It should be stressed that I am not a specialist in coccyx pain, only a fellow sufferer who wants to get better recognition and treatment of this painful condition for all of us.
 
EARLY INTERVENTION IS ESSENTIAL TO DECREASE CHANCES OF CONDITION BECOMING CHRONIC

PLEASE MAKE SURE YOUR GP IS LISTENING TO YOU. ASK THEM TO REFER YOU ON TO A SPECIALIST. MAKE SURE THEY ARE TAKING YOU SERIOUSLY. DO NOT JUST LET THEM GIVE YOU ANALGESIA AND TELL YOU IT WILL GET BETTER OVER TIME. TIME WILL INEVITABLY WORSEN THIS CONDITION AND IT WILL BECOME CHRONIC.

Considerations – (a thorough history is required).
External examination/palpation and observation.
·         Age

·         Gender

·         Childbirth- any complications

·         Where is pain

·         What makes pain worse

·         Severity of pain

·         Any injuries, old or new

·         Duration of pain

·         Type of pain

·         Any numbness

·         Mood- any low mood/depression

·         Job- is it sedentary
 
Consider causes
·         Degenerative changes- wear and tear

·         Breaks, fractures, damage, inflammation

·         Hypermobility

·         Ischial bursitis

·         Repetitive Strain injury

·         Poor posture

·         Muscular involvement (e.g. buttocks)

·         Piriformis Syndrome

·         Cysts (Internal-e.g. ovarian (females), external e.g. Pilonidal)

·         Pelvic Congestion/varices (females)

·         Fibroids – any symptoms (females)

·         Tumours

·         In men- prostate involvement

·         Bowel involvement- any symptoms

·         Urinary tract involvement- any symptoms

·         Over or under weight

·         Any contraceptive coil in situ- do dates coincide (females)

·         Consider referred pain- pelvic floor muscles, other parts of spine 
 

Appropriate diagnostic tools
·         X-Ray- dynamic sit/stand- HAS to be sit AND stand!!

·         MRI- MUST include coccyx!! (Often do not unless requested)

·         If gynaecological complications/possibilities consider CT and/or laparoscopy

·         If bowel complications/possibilities consider colonoscopy, sigmoidoscopy

·         Bloods (e.g. hormone levels such as oestrogen in menopausal women may effect pain) 

EARLY INTERVENTION TO DECREASE CHANCES OF CONDITION BECOMING CHRONIC! 

Treatments to consider

Will depend on what is found

·        Recent or obvious injury to coccyx or degenerative changes may require/benefit from specialist physio, Manipulation Under Anaesthetic (MUA) and steroid injection, or removal of coccyx- coccygectomy removal should be last resort (in my opinion).

·        An old Injury that now involves muscles may benefit from a specialist physio, and/or MUA and steroid injection.

·         Gynaecological complications- refer to Gynaecologist.

·         Bowel complications- refer to Gastro-Intestinal specialist (GI).

·         Pain management Specialist, patient may benefit from nerve block.

·         Prolotherapy may help sprains in pelvic floor.

·         Some people find TENS Machine helps, acupuncture, massage, relaxation.

·         Consider use of a heat pad.

·         Manage pain with analgesia and/or Cognitive Therapy.

·         Consider specialist cushions and conservative management. 

I have found exercise helps-walking and running, and some weights, but this would not suit everyone. I was warned against yoga and heavy weights due to degeneration of my coccyx and lower spine. I also swear by my heat pad.
 

Referrals to consider
·         Trauma and/or orthopaedics

·         Specialist physio

·         General physio

·         Pain management

·         GI Specialist

·         Gynaecologist

·         Chiropractor

 Some people may benefit from Cognitive Behavioural Therapy to help them learn to cope with the pain.
There are so many possible causes of coccydynia. It may well be just the coccyx involved, but it may also be caused or aggravated by other factors. In my opinion one should explore all reasonable, likely, possible causes. Do not assume the pain is just coming from the coccyx. It may be referred pain from nearby muscles, or organs.
I am sure the list above is not exhaustive. I have compiled it from my own history and knowledge from being a nurse - which is obviously limited. As I said - I am not a specialist, just a coccydynia sufferer.

 

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