{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:43:00Z","timestamp":1792582980463,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n To characterize daily pain trajectories after standardized three-position coccygeal infiltration and explore differences by clinical and radiographic subgroups.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Prospective, single-arm observational cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Specialized orthopedic and spine care setting.<\/jats:p>\n <\/jats:sec>\n \n Subjects<\/jats:title>\n Patients had chronic coccygodynia with symptomatic coccygeal instability confirmed clinically and on paired standing and seated lateral radiographs. Of 668 treated patients receiving a diary, 274 returned complete diaries and were analyzed (41.0%); 394 did not return a diary (59.0%).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients were treated prone without procedural imaging guidance. Through one skin entry, a 23-gauge needle was directed sequentially to the symptomatic mobile segment, coccygeal tip, and immediately lateral to the coccyx. The standard injectate was mepivacaine 1% (5\u2009mL) plus triamcinolone 40\u2009mg. NRS pain was recorded before infiltration (day 0) and daily through post-injection day 27. Responder thresholds were \u226530%, \u226550%, and, supplementarily, \u22652-point improvement.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Mean NRS was 5.55 at baseline, increased transiently on post-injection days 1 and 2, and was below baseline on day 3. By day 27, mean NRS was 1.99 (paired change, \u22123.56; 95% CI, \u22123.90 to\u2009\u2212\u20093.22; P\u2009&lt;\u20090.001; Cohen dz\u2009=\u20091.24); 220 patients (80.3%) achieved \u226530% improvement and 192 (70.1%) achieved \u226550% improvement. Mean pain decreased further from 3.51 in diary week 3 to 2.73 in diary week 4 (change, \u22120.78; 95% CI, \u22120.95 to\u2009\u2212\u20090.61; P\u2009&lt;\u20090.001; Cohen dz\u2009=\u20090.55). More than half of day-20 nonresponders achieved responder status by day 27.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Three-position coccygeal infiltration was followed by substantial pain reduction through day 27, including further improvement during diary week 4. Causal efficacy cannot be established without a comparison group, and responder estimates may not represent the entire treated population because 59.0% did not return diaries.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/pm\/pnag142","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T11:37:13Z","timestamp":1792323433000},"source":"Crossref","is-referenced-by-count":0,"title":["Twenty-Eight-Day Pain Trajectories After Standardized Three-Position Coccygeal Infiltration: A Prospective Observational Study of 274 Patients"],"prefix":"10.1093","author":[{"given":"Loreto C","family":"Pulido","sequence":"first","affiliation":[{"name":"Klinikum Fichtelgebirge Department of Orthopaedics and Trauma Surgery, Section of Orthopaedics and Spine Surgery, , 95615 Marktredwitz,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Koehl","sequence":"additional","affiliation":[{"name":"Klinikum Fichtelgebirge Department of Orthopaedics and Trauma Surgery, , 95615 Marktredwitz,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Schuh","sequence":"additional","affiliation":[{"name":"Klinikum Fichtelgebirge Department of Orthopaedics and Trauma Surgery, Section of Musculoskeletal Research, , 95615 Marktredwitz,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2251-7284","authenticated-orcid":false,"given":"Achim","family":"Benditz","sequence":"additional","affiliation":[{"name":"Klinikum Fichtelgebirge Department of Orthopaedics and Trauma Surgery, Section of Orthopaedics and Spine Surgery, , 95615 Marktredwitz,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,19]]},"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/painmedicine\/advance-article-pdf\/doi\/10.1093\/pm\/pnag142\/72115441\/pnag142.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/advance-article-pdf\/doi\/10.1093\/pm\/pnag142\/72115441\/pnag142.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:08:25Z","timestamp":1792580905000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/advance-article\/doi\/10.1093\/pm\/pnag142\/8943605"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/pm\/pnag142","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"article-number":"pnag142"}}