In a letter to the editor in Pain Medicine, Dr. Foye, Director of the Coccyx Pain Center in New Jersey, describes how physicians trivialize patients who have coccyx pain. Patients report being told that there is no cure and that the pain is imagined. Dr. Foye reports that patients who have coccyx pain have similar psychological profiles as any patient with chronic pain. Patients who present with coccyx pain frequently present with pain in other sites such as the low back, buttocks, pelvis or thighs. Even when patients present to the clinic with localized tailbone pain, finding a means to alleviate the pain that usually limits sitting can be challenging.
De Andres and Chaves, who in 2003 proposed an algorithm for the treatment of coccygodynia, describe the potential causes of coccygodynia, or coccyx pain. They list somatic, neuropathic, and mixed presentations of pain. For somatic presentations, mechanical issues such as falling on the tailbone, levator ani syndrome, or postural habits creating micro trauma are described. Neuropathic presentations of coccyx pain can include referred pain from dural irritation, sacral nerve schwannomas, arachnoid cysts in cauda equine syndrome, or sacrococcygeal meningeal cysts. Space-occupying lesions, through rapid growth, can also affect both somatic structures such as joints and ligaments, and eventually encroach upon neural tissues. This list of causes suggests that medical providers and rehabilitation providers must work closely together to determine causes of coccyx pain that require medical intervention versus those that will respond to rehabilitation techniques.