The Korean Journal of Pain

  • 제32권4호
  • /
  • Pages.301-306
  • /
  • 2019
  • /
  • 2005-9159(pISSN)
  • /
  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
권호 표지
DOI QR코드

DOI QR Code

Are steroids required in the treatment of ganglion impar blockade in chronic coccydynia? a prospective double-blinded clinical trial

  • Sencan, Savas (Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University) ;
  • Edipoglu, Ipek Saadet (Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University) ;
  • Demir, Fatma Gul Ulku (Department of Physical Medicine and Rehabilitation, Kayseri City Hospital) ;
  • Yolcu, Gunay (Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University) ;
  • Gunduz, Osman Hakan (Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University)
  • 투고 : 2019.06.27
  • 심사 : 2019.08.09
  • 발행 : 2019.10.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Ganglion impar blockade is a reliable and effective treatment option used in patients with coccydynia. Our primary objective was to specify the role of corticosteroids in impar blockade. We compared applications of local anesthetic with the local anesthetic + corticosteroid combination in terms of treatment efficiency in patients with chronic coccydynia. Methods: Our study was a prospective randomize double-blind study. The patients were divided into 2 groups after randomization. The first group (group SL) was made up of patients where a corticosteroid + local anesthetic were used during ganglion impar blockade. In the second group (group L) we used only local anesthetic. We evaluated numeric rating scale (NRS) and Beck depression scale, which were employed before the procedure and in 1st and 3rd months after the procedure. Results: Seventy-three patients were included in the final analysis. We detected a significantly greater decrease in NRS values in the 1st month in group SL than in group L (P = 0.001). In the same way, NRS values in the 3rd month were significantly lower in the group with steroids (P = 0.0001). During the evaluation of the Beck test, we detected significantly greater decreases in the 1st month (P = 0.017) and 3rd month (P = 0.021) in the SL group than in the L group. Conclusions: Ganglion impar blockade decreases pain in the treatment of chronic coccydynia and improve depression. Addition of steroids in a ganglion impar blockade is required for treatment response that should accumulate over a long period of time.

키워드

참고문헌

  1. Nathan ST, Fisher BE, Roberts CS. Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br 2010; 92: 1622-7. https://doi.org/10.1302/0301-620X.92B12.25486
  2. Maigne JY, Guedj S, Straus C. Idiopathic coccygodynia. Lateral roentgenograms in the sitting position and coccygeal discography. Spine (Phila Pa 1976) 1994; 19: 930-4. https://doi.org/10.1097/00007632-199404150-00011
  3. De Andres J, Chaves S. Coccygodynia: a proposal for an algorithm for treatment. J Pain 2003; 4: 257-66. https://doi.org/10.1016/S1526-5900(03)00620-5
  4. Maroy B. Spontaneous and evoked coccygeal pain in depression. Dis Colon Rectum 1988; 31: 210-5. https://doi.org/10.1007/BF02552548
  5. Maigne JY, Chatellier G, Faou ML, Archambeau M. The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine (Phila Pa 1976) 2006; 31: E621-7. https://doi.org/10.1097/01.brs.0000231895.72380.64
  6. Plancarte R, Amescua C, Patt RB, Allende S. Presacral blockade of the ganglion of Walther (ganglion impar). Anesthesiology 1990; 73: A751.
  7. Leppert W, Buss T. The role of corticosteroids in the treatment of pain in cancer patients. Curr Pain Headache Rep 2012; 16: 307-13. https://doi.org/10.1007/s11916-012-0273-z
  8. Carr CM, Plastaras CT, Pingree MJ, Smuck M, Maus TP, Geske JR, et al. Immediate adverse events in interventional pain procedures: a multi-institutional study. Pain Med 2016; 17: 2155-61. https://doi.org/10.1093/pm/pnw051
  9. Gunduz OH, Sencan S, Kenis-Coskun O. Pain relief due to transsacrococcygeal ganglion impar block in chronic coccygodynia: a pilot study. Pain Med 2015; 16: 1278-81. https://doi.org/10.1111/pme.12752
  10. Wray CC, Easom S, Hoskinson J. Coccydynia. Aetiology and treatment. J Bone Joint Surg Br 1991; 73: 335-8.
  11. Sencan S, Cuce I, Karabiyik O, Demir FU, Ercalik T, Gunduz OH. The influence of coccygeal dynamic patterns on ganglion impar block treatment results in chronic coccygodynia. Interv Neuroradiol 2018; 24: 580-5. https://doi.org/10.1177/1591019918781673
  12. Buttaci C, Foye PM, Stitik TP. Coccygodynia successfully treated with ganglion Impar blocks: a case series. Am J Phys Med Rehabil 2005; 85: 783-4. https://doi.org/10.1097/01.phm.0000233174.86070.63
  13. Turchan A, Fahmi A, Subianto H. Impar ganglion block with combination of neurolysis drugs and radiofrequency thermocoagulation for perineal pain. Asian J Neurosurg 2018; 13: 838-41.
  14. Akturk Z, Dagdeviren N, Ture M, Tugcu C. The reliability and validity analysis of the Turkish version of Beck Depression Inventory for primary care. Turk Aile Hek Derg 2005; 9: 117-22.
  15. Schilling LS, Markman JD. Corticosteroids for pain of spinal origin: epidural and intraarticular administration. Rheum Dis Clin North Am 2016; 42: 137-55. https://doi.org/10.1016/j.rdc.2015.08.003
  16. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids--new mechanisms for old drugs. N Engl J Med 2005; 353: 1711-23. https://doi.org/10.1056/NEJMra050541
  17. Markman JD, Kress BT, Frazer M, Hanson R, Kogan V, Huang JH. Screening for neuropathic characteristics in failed back surgery syndromes: challenges for guiding treatment. Pain Med 2015; 16: 520-30. https://doi.org/10.1111/pme.12612
  18. De Bosscher K, Vanden Berghe W, Haegeman G. The interplay between the glucocorticoid receptor and nuclear factorkappaB or activator protein-1: molecular mechanisms for gene repression. Endocr Rev 2003; 24: 488-522. https://doi.org/10.1210/er.2002-0006
  19. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med 2003; 163: 2433-45. https://doi.org/10.1001/archinte.163.20.2433
  20. Gonnade N, Mehta N, Khera PS, Kumar D, Rajagopal R, Sharma PK. Ganglion impar block in patients with chronic coccydynia. Indian J Radiol Imaging 2017; 27: 324-8. https://doi.org/10.4103/ijri.IJRI_294_16
  21. Paganelli MA, Popescu GK. Actions of bupivacaine, a widely used local anesthetic, on NMDA receptor responses. J Neurosci 2015; 35: 831-42. https://doi.org/10.1523/JNEUROSCI.3578-14.2015
  22. Le Clerc QC, Riant T, Levesque A, Labat JJ, Ploteau S, Robert R, et al. Repeated ganglion impar block in a cohort of 83 patients with chronic pelvic and perineal pain. Pain Physician 2017; 20: E823-8.

피인용 문헌

  1. Steroids further improve ganglion impar blocks for coccyx pain (tailbone pain) vol.33, pp.4, 2020, https://doi.org/10.3344/kjp.2020.33.4.400
  2. Author's reply vol.33, pp.4, 2019, https://doi.org/10.3344/kjp.2020.33.4.401
  3. The efficacy of coccygectomy in patients with persistent coccydynia : a retrospective cohort study of 134 consecutive patients with a minimum follow-up of one year vol.b103, pp.3, 2019, https://doi.org/10.1302/0301-620x.103b3.bjj-2020-1045.r2
  4. Comparison of treatment outcomes in chronic coccygodynia patients treated with ganglion impar blockade versus caudal epidural steroid injection: a prospective randomized comparison study vol.35, pp.1, 2019, https://doi.org/10.3344/kjp.2022.35.1.106