Focus of the Report: The focus of this Health Technology Assessment is to evaluate the effectiveness and safety of ganglion impar block (GIB) or radiofrequency thermocoagulation (RFT) of the ganglion impar to treat chronic pain in adults with chronic coccydynia.
Technology Description: The ganglion impar is found on the frontal surface of the coccyx, forming the top of the bilateral sympathetic chain. Therapeutic intervention to the ganglion impar may be performed with a GIB or RFT of the ganglion impar. A GIB is typically performed by fluoroscopically injecting bupivacaine (anesthetic), saline, and prednisolone. RFT of the ganglion impar is performed by fluoroscopically positioning a radiofrequency needle and ablating the nerve at 80 °C for 80 to 90 seconds.
Controversy: Coccydynia is a rare condition, with the majority of patients responding to conservative management. Controversies surrounding GIB and RFT of the ganglion impar include whether the interventions are efficacious and safe for the treatment of coccydynia, the durability of effect, and cost-effectiveness. In addition, there is uncertainty revolving around appropriate patient selection criteria for the use of GIB and RFT for the treatment of chronic coccydynia.
Key Questions:
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Is GIB effective for the treatment of chronic coccydynia?
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Is RFT of the ganglion impar effective for the treatment of chronic coccydynia?
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How does GIB compare with other treatments for chronic coccydynia?
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How does RFT of the ganglion impar compare with other treatments for chronic coccydynia?
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Is GIB in patients with chronic coccydynia safe?
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Is RFT of the ganglion impar in patients with chronic coccydynia safe?
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Have definitive patient selection criteria been identified for GIB or RFT of the ganglion impar for the treatment of chronic coccydynia?
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