Ganglion Impar Block and Pulsed Radiofrequency Under Fluoroscopic Guidance in Chronic Coccydynia: A Retrospective Case Series.

Introduction Chronic coccydynia is characterized by persistent pain in the coccygeal region and can significantly impair functionality and quality of life. While most patients respond to conservative treatments, some experience refractory pain that may benefit from minimally invasive interventions, such as ganglion impar block and/or pulsed radiofrequency (PRF). This study aims to investigate the effectiveness and safety of fluoroscopy-guided ganglion impar block and/or PRF in patients with chronic coccydynia refractory to conservative treatments. Methods We conducted a retrospective case series involving 24 patients with coccydynia lasting at least three months, who underwent ganglion impar block and/or PRF between 2021 and 2025. Clinical data - namely, demographics, comorbidities, history of trauma, vaginal delivery or tumours, sacrococcygeal joint dysfunction, and pain intensity measured with the Numerical Rating Scale (NRS) before and at one, three, and six months post-procedure - were collected and analysed descriptively. Results Our case series included 24 patients (91.7% females), who were naïve to minimally invasive treatments for coccydynia, with a mean age of 46.1 ± 15.9 years and a mean BMI of 24.2 ± 5.3 kg/m². Of the total 24 patients, 14 (58.3%) underwent a ganglion impar block. These patients presented a baseline mean NRS of 8.4 ± 1.4 and reported a mean pain reduction of 64% at one month after the procedure, 60% at three months, and 50% at six months. On the other hand, 10 (41.7%) patients were submitted to PRF of the ganglion impar after an immediate positive response to the ganglion impar block. These patients presented a baseline mean NRS of 8.5 ± 1.4 and yielded mean pain reductions of 73% at one month, 62% at three months, and 49% at six months. Three (12.5%) patients with comorbid anxiety and depression experienced meaningful pain relief, regardless of the procedure performed. Patients whose severe coccydynia returned after initial relief underwent repeat ganglion impar block or PRF; repeated procedures showed diminished efficacy, with lower pain relief observed at six months compared to the initial intervention (mean pain reductions of 21% and 38% at six months, respectively). All interventions were performed safely, with no reported complications. Conclusion Fluoroscopy-guided ganglion impar block and PRF appear to be safe and effective initial interventions for managing chronic coccydynia refractory to conservative treatment. Our data demonstrated clinically meaningful and similar pain relief for up to six months with both procedures. Modest pain relief was observed with repeated ganglion impar block or PRF. Further research with larger patient cohorts is warranted to determine optimal subsequent options, for example, thermal radiofrequency of the ganglion impar or sacrococcygeal nerves, or chemical neurolysis, following an initial response to a ganglion impar block or PRF.