Systematic review shows ganglion impar block offers better short-term pain relief than caudal epidural steroid injection in coccydynia treatment, suggesting distinct roles for each method.
Background: Coccydynia is a chronic pain condition affecting the coccyx, often resulting in significant discomfort and reduced quality of life. It disproportionately affects women, especially following childbirth. While conservative management is effective in most cases, a subset of patients remains refractory and requires interventional treatments. Ganglion Impar Block (GIB) and Caudal Epidural Steroid Injection (CESI) are two widely used procedures, each with distinct mechanisms. However, a clear comparative evaluation is lacking, particularly regarding their integration with physical rehabilitation strategies. Objective: To systematically evaluate and compare the clinical effectiveness and safety of GIB and CESI in the treatment of chronic coccydynia, with particular attention to pain relief, functional improvement, and quality of life outcomes. Methods: This systematic review adhered to PRISMA guidelines and included studies published between January 2015 and March 2025 from PubMed, Cochrane Library, and Google Scholar. Nineteen studies—including 6 randomized controlled trials, 8 retrospective studies, and 1 narrative review—were selected based on predefined eligibility criteria. Included studies reported on adults with chronic coccydynia treated with either GIB or CESI. Data on pain (VAS/NRS), function (ODI), and quality of life (SF-12) were extracted and qualitatively synthesized due to methodological heterogeneity. Results: GIB demonstrated superior short-term pain relief, with an average VAS reduction of 5.2 ± 1.3 compared to 3.8 ± 1.1 for CESI (p<0.05). In neuropathic presentations (LANSS ≥12), GIB was significantly more effective. Both interventions improved functional outcomes and SF-12 scores by week 3, although benefits diminished by 3 months. Adverse events were minor, including transient syncope and superficial bruising. There was limited evidence supporting the efficacy of combined GIB and CESI or their use alongside physiotherapy. Conclusion: GIB is more effective for short-term pain control in chronic coccydynia, particularly in neuropathic cases, while CESI remains valuable in inflammatory profiles. Both are safe and improve patient function. Future randomized trials should assess multimodal strategies, including physiotherapy, to optimize treatment algorithms.
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