Chronic Pelvic Pain; a tragic miss

Abstract

Chronic pelvic pain is defined as pain in the perineal region that can be somatic or visceral in origin which persists for more than 6 months duration and is unresponsive to analgesic therapy. Its diagnosis is made on the basis of patient’s history, detailed physical examination and radiological studies. One of the important, rare and mostly missed cause of this pain is coccydynia either traumatic or atraumatic. The treatment of coccydynia includes supportive care, analgesic therapy as well as ganglion impar neurolysis. Here, we report a case of a 42-year-old female suffering from severe chronic pelvic pain for past 15 years for which she had taken multiple analgesics including opiates and underwent multiple surgeries without any relief. She was a misdiagnosed case of coccygeal fracture which was causing chronic pelvic pain for the past 15 years which when treated with ganglion impar neurolysis gave her complete pain relief.  After 1 month of the intervention, on follow up in the pain clinic the patient was absolutely pain free with NRS 1/10.Coccydynia must be considered in differential diagnosis of chronic pelvic pain especially in females of child bearing age.