Coccyx Nasal Calcitonin

A recent publication of a case series proposes that clinicians use intranasal calcitonin, a medication prescribed for acute vertebral fractures in osteoporotic patients, for acute coccyx pain. This medication is administered as a nasal spray, has been demonstrated to have analgesic properties, and is theorized to have effects of beta-endorphin production, and inhibition of prostaglandin and cytokine production. Nasal calcitonin, a synthetic drug, is reported to have fewer and mild side effects when compared with the injectable form of the medication.

Of the 8 subjects treated and described in the case series, all had a fall on the tailbone, either landing hard into a chair on onto the stairs or floor. Some were seen within 3 months of injury date, and others were treated after 3 months from injury. The authors report that in the subjects who were treated acutely, 3 of 5 had at least 50% improvement in pain, without injections or surgery. The subjects treated in a chronic pain condition had similar levels of improvement but with the addition of coccyx injections for treatment.

Based on the lack of a control group, the small number of subjects treated, and because the mechanism of nasal calcitonin is unknown as far as effects on fracture healing in the coccyx, we would not, as rehab professionals, look to our referring providers to add nasal calcitonin routinely in the management of acute coccyx fracture. This article may, however, lead to interesting conversations with referring providers who are in a position to consider the addition of calcitonin for the proposed analgesic effect and potential bone healing augmentation. (The authors do suggest using the smallest effective dose for the shortest duration required.)

Clinically, is the difference in recovery for acute versus chronic coccyx pain of interest? Ideally, we would get to work with patients very soon after an injury, so that education is in place about self-care, self-treatment, optimal movement and thought patterns. The earlier that we can help a patient alleviate muscle tension and pain, and increase movement within tolerance, the better the outcomes usually are for the patient, as patterns of inactivity, fear, and muscle guarding are less likely to have set in. To learn much more about treatment of the coccyx, join faculty member Lila Abate in New Hampshire this September for the Coccyx Pain: Evaluation and Treatment continuing education course.