Savas Sencan, Ipek Saadet Edipoglu, Fatma Gul Ulku Demir, Gunay Yolcu, and Osman Hakan Gunduz. Korean J Pain 2019;32:301-6. https://doi.org/10.3344/kjp.2019.32.4.301

Savas Sencan, Gunay Yolcu, Serhad Bilim, Ozge Kenis-Coskun, and Osman Hakan Gunduz. Korean J Pain 2022;35:106-13. https://doi.org/10.3344/kjp.2022.35.1.106

Objective: Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB. Materials and methods: We retrospectively analyzed the data for patients diagnosed with chronic coccygodynia who underwent GIB only once by a transsacrococcygeal method under fluoroscopy guidance in our Pain Medicine Clinic. Patients were assessed with standard and dynamic coccyx radiographs and classified according to coccygeal mobility. Pain scores were assessed with a numerical rating scale (NRS) before and after the intervention (at 1 hour and 4, 12 and 24 weeks). A 50% or more reduction in the NRS score was accepted as significant pain relief. Results: Of the 37 patients included in the study, 14 had normal coccyx (Group I) and 23 had immobile coccyx (Group II) based on the radiological evaluation. The NRS scores were significantly reduced in both groups on each follow-up visit but there was no significant difference between the two groups in terms of pre- and post-intervention NRS scores. Significant pain relief was achieved in 42.9% and 61.9% of patients in Group I and II at the last examination, respectively. Conclusion: GIB administered by transsacrococcygeal method in patients with chronic coccygodynia is a safe and alternative treatment approach with reduced pain scores and low complication rates. In patients with chronic coccygodynia, having a normal or immobile coccyx does not appear to affect treatment outcomes.

Epidural steroid injections are frequently performed to manage radicular symptoms. Most research investigating the effectiveness of different routes of epidural injections were conducted with non-homogeneous groups. In this study our aim was to investigate the efficacy of caudal versus transforaminal approaches in patients with unilateral S1 radiculopathy secondary to a paracentral L5-S1 disc herniation. Prospective, randomized clinical trial. A university hospital pain management center. The study was conducted between January 2022 and February 2023. Patients with unilateral S1 radiculopathy were randomly divided into two groups: the caudal epidural steroid injection (CESI) and the transforaminal epidural steroid injection (TFESI) group. Severity of pain and disability were assessed with Numeric Rating Scale (NRS-11) and Oswestry Disability Index (ODI) at baseline, 3 weeks, and 3 months after treatment. 50% or more improvement in NRS-11 was defined as treatment success. Fluoroscopy time and doses of exposed radiation were also recorded. A total of 60 patients were included in the final analysis (n = 30 for each group). Significant improvement in pain and disability scores was observed at 3^rd week and 3^rd month compared to baseline (p < 0.001). Treatment success rate at 3^rd month was 77% for the CESI group and 73% for the TFESI group without any significant difference between the groups (p = 0.766). CESI is equally effective as TFESI in the management of S1 radiculopathy due to a paracentral L5-S1 disc herniation. Both approaches can reduce pain and disability while CESI requires shorter fluoroscopy time and less radiation exposure.

Savas Sencan, Ipek Saadet Edipoglu, Alp Eren Celenlioglu, Gunay Yolcu, and Osman Hakan Gunduz. Korean J Pain 2020;33:226-33. https://doi.org/10.3344/kjp.2020.33.3.226