THE COMPARISON OF EFFICACY OF STEROID INJECTION VERSUS ORAL NSAIDS AND PHYSIOTHERAPY IN THE MANAGEMENT OF COCCYDYNIA

Background: Coccydynia is a debilitating condition causing chronic coccygeal pain. This study aimed to compare the therapeutic efficacy of three treatment modalities: fluoroscopically guided corticosteroid injections, oral NSAIDs, and physiotherapy combined with NSAIDs. Methods: In this randomized clinical trial, 120 patients with coccydynia were stratified into three matched groups. Group A received fluoroscopically guided methylprednisolone acetate (40mg) with lidocaine (1%), Group B was administered celecoxib (200mg BID) with adjunctive tailbone pillow use, while Group C underwent physiotherapy with NSAID therapy. Clinical outcomes were assessed over a 4-month follow-up period. Results: All interventions demonstrated statistically significant pain reduction versus baseline (p<0.001). Comparative analysis revealed that fluoroscopically guided injections produced significantly greater pain relief than both oral NSAIDs (mean difference: 2.3 VAS points, p=0.008) and physiotherapy with NSAIDs (mean difference: 1.9 VAS points, p=0.012). Age-stratified analysis identified patients aged 41-50 years as having the highest pain burden at presentation. Conclusion: Fluoroscopically guided corticosteroid injections were significantly more effective in pain reduction compared to pharmacological or physiotherapeutic approaches. These findings support their consideration as first-line therapy for moderate-to-severe coccydynia, particularly in cases refractory to conservative management.