{
  "abstract": "Background/Importance Chronic coccydynia is a challenging condition to manage. Conflicting evidence exists regarding the role of the ganglion impar in coccygeal nociception. When conservative treatments fail, minimally invasive interventions at the ganglion impar may be effective in providing relief.Objectives To evaluate the effectiveness and safety of ganglion impar blocks (GIBs) for the management of chronic coccydynia.Evidence review A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through a comprehensive literature search of PubMed, Embase Classic+ Embase, CINAHL and the Web of Science in February 2024. Data on patient characteristics, intervention details, pain outcomes (measured by Visual Analog Scale and Numerical Pain Rating Scale) and adverse events were extracted. Meta-analysis was performed using standardized mean differences (SMDs) on scale of 0 to 10.Findings Seventeen studies described 625 coccydynia patients treated with GIB. All studies reported some level of improvement of pain after GIB. The meta-analysis included 11 studies totaling 391 patients with a baseline pain score of 7.93 (7.81 to 8.04 95% CI). GIBs were effective in reducing coccygeal pain at short-term (up to 3 months), intermediate-term (3–6 months) and long-term (greater than 6 months) follow-up. SMDs were −2.73 (95% CI −3.45 to −2.01), −2.13 (95% CI −2.82 to −1.45), −1.86 (95% CI −2.58 to −1.15) at 3 months, 3–6 months and >6 months, respectively. No serious adverse events were noted. Grading of Recommendations Assessment, Development and Evaluation assessment indicated ‘very low’ certainty of evidence across all outcomes.Conclusions Non-neurodestructive GIB may be a safe and potentially effective treatment option for patients with chronic, refractory coccydynia.PROSPERO registration number CRD42024506056.",
  "authors": [
    {
      "affiliations": [
        "Physical Medicine & Rehabilitation, New York University School of Medicine, New York, NY, USA"
      ],
      "name": "David S Jevotovsky"
    },
    {
      "affiliations": [
        "Physical Medicine & Rehabilitation, Johns Hopkins Medicine, Baltimore, MD, USA"
      ],
      "name": "Harman Chopra"
    },
    {
      "affiliations": [
        "Pain Medicine Division, University of Texas at Houston , Houston, TX, USA"
      ],
      "name": "Daniel J Pak"
    },
    {
      "affiliations": [
        "Physical Medicine & Rehabilitation, New York University School of Medicine, New York, NY, USA"
      ],
      "name": "Eric A Grin"
    },
    {
      "affiliations": [
        "Physical Medicine & Rehabilitation, New York University School of Medicine, New York, NY, USA"
      ],
      "name": "Adhith Palla"
    },
    {
      "affiliations": [
        "Anesthesiology, Pain Medicine Division, Vanderbilt University School of Medicine, Nashville, TN, USA"
      ],
      "name": "Shravani Durbhakula"
    },
    {
      "affiliations": [
        "Physical Medicine & Rehabilitation, New York University School of Medicine, New York, NY, USA"
      ],
      "name": "Sidharth Sahni"
    },
    {
      "affiliations": [
        "Interventional Pain, Icahn School of Medicine at Mount Sinai, New York, NY, USA"
      ],
      "name": "Tariq AlFarra"
    },
    {
      "affiliations": [
        "Pain Medicine, University of California San Diego, San Diego, California, USA"
      ],
      "name": "Mustafa Y Broachwala"
    },
    {
      "affiliations": [
        "Pain Medicine, Weill Cornell Medicine , New York, NY, USA"
      ],
      "name": "Anuj Shah"
    },
    {
      "affiliations": [
        "Physical Medicine & Rehabilitation, New York University School of Medicine, New York, NY, USA"
      ],
      "name": "Richard Lau"
    },
    {
      "affiliations": [
        "Physical Medicine & Rehabilitation, Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA"
      ],
      "name": "Alexander Shustorovich"
    },
    {
      "affiliations": [
        "Physical Medicine & Rehabilitation, New York University School of Medicine, New York, NY, USA"
      ],
      "name": "Michael Flamm"
    },
    {
      "affiliations": [
        "North Texas Orthopedics and Spine Center, Grapevine, TX, USA"
      ],
      "name": "Melissa Murphy"
    },
    {
      "affiliations": [
        "Spine and Nerve Center of the Virginias, West Virginia University—Health Sciences Campus, Morgantown, WV, USA"
      ],
      "name": "Timothy Deer"
    },
    {
      "affiliations": [
        "Memorial Sloan Kettering Cancer Center, New York, NY, USA"
      ],
      "name": "Amitabh Gulati"
    },
    {
      "affiliations": [
        "University of Pittsburgh Medical Center, Williamsport, PA, USA"
      ],
      "name": "Vwaire Orhurhu"
    }
  ],
  "title": "Non-neurodestructive ganglion impar blocks for coccydynia and related disorders: a systematic review and meta-analysis",
  "uid": "316fe5e5-8a37-521d-9f56-9d9bc553958f"
}