Management of Coccydynia: A Prospective, Observational Study of Coccygectomy
Conditions: Coccygodynia
Sponsor: Wake Forest University Health Sciences

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TITLE OF PROTOCOL:  Management of Coccygodynia: A prospective, observational 
study of coccygectomy  
 
 
1. 
INVESTIGATORS 
 
Principal Investigator: 
Edward N. Hanley, MD  
Department of Orthopaedic Surgery 
1616 Scott St.  
Charlotte, NC 28203 
(704) 355-5026 
 
 
Co-Investigators: 
Nady Hamid, MD 
Bryan Loeffler, MD 
Ben Jackson, MD 
Department of Orthopaedic Surgery 
1616 Scott St.  
Charlotte, NC 28203 
 (704) 355-3184 
 
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Purposes: 
1. To analyze the outcomes of patients treated with coccygectomy for 
coccygodynia and report on the rate of complications of this procedure. 
2. To find pre-operative clinical predictors of good outcomes after 
coccygectomy. 
 
Null Hypotheses: 
1. Coccygectomy will not improve scores on the SF-36, ODI, tolerable sitting time, 
or VAS. 
2. There are no independent variables associated with improved outcomes. 
 
Background and Significance: 
 
The term coccygodynia was coined in 1859 by Simpson to describe the symptoms of pain 
in the area of the coccyx. “Coccyx” is derived from the word “cuckoo” because of its 
resemblance to a bird’s beak (4). This region represents the terminal end of the spinal 
column and consists of three to four fused coccygeal vertebral segments. Patients with 
pain in this area have a higher incidence of sacrococcygeal fusion and more angular 
sagittal alignment of the coccyx compared to asymptomatic patients. Coccygodynia is 
five times more prevalent in women than men.  The mean age of onset is 40 years, but 
can occur through a wide range of ages. Coccygodynia has many causes. It can begin 
insidiously and have no history of trauma. It can also begin after a fall with a contusion 
over the buttock or after a difficult vaginal delivery. Obesity is also three times more 
common in patients with coccygodynia than in the general population.  
 
Clinical presentation: 
The main clinical symptom is pain. Pain may slowly progress insidiously or begin acutely 
after a traumatic event. Typically pain is localized directly over the coccyx with no 
associated low back pain or referred pain. Sitting is typically the worst position for these 
patients and pain with defecation or sexual activity is common. Physical examination 
typically reveals tenderness to palpation at the coccyx. Rectal exam may reveal a tender, 
mobile, distal coccygeal segment. 
 
Imaging: 
Much attention has been paid to the radiographic findings in coccygodynia.  Postacchini 
and Massobrio reported that single position radiographs seldom show differences 
between normal individuals and those with coccygodynia (9). Maigne et al compared 
standing and sitting radiographic views of the coccyx in a total of 582 patients with 
coccygodynia and found abnormalities in 70% of the patients (7) (figure 1). 
Hypermobility of greater than 25 degrees, posterior subluxation of a mobile segment, or a 
coccygeal spicule can all be seen with sitting radiographs and are consistent with 
coccygodynia (figure 2).   
 
Non-operative Treatment: 
All patients presenting with coccygodynia should be initially treated conservatively.  
Treatment modalities include non-steroidal anti-inflammatory and analgesic medications, 

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rest, and cushion support.  Rarely, physical therapy with diathermy and ultrasound may 
be prescribed, although there is no evidence to support its role.  After initial conservative 
management, corticosteroid injections may be performed. Wray et al reported a cure rate 
of 59% with local steroid injection alone, and an 85% cure rate when injection was 
combined with manipulation under anesthesia. There was a 21% relapse rate in this group 
of patients (11). Maigne and Chatellier attempted conservative treatment with levator ani 
muscle massage, joint mobilization and stretching exercises and found only a 25% 
success rate (7).  
 
Surgical Treatment: 
When conservative treatment for coccygodynia fails, removal of the coccyx 
(coccygectomy) may be considered.  Both significant, disabling pain and radiographic 
abnormalities should be present before surgical consideration. Surgery consists of either 
complete removal of the coccyx or excision of the mobile segment. The most common 
complication is wound infection and dehiscence due to perineal contamination (8, 10).  
Maigne et al prospectively followed 37 patients treated with coccygectomy and found 34 
of 37 had good to excellent results at minimum of 2 years. Doursounian et al reported on 
61 patients treated with coccygectomy, which is the largest retrospective case series 
published (3).  They found good to excellent results in 53 of 61 patients. Nine patients in 
this study developed an infection requiring re-operation.  Wood and Mehbod compared 
20 patients treated with coccygectomy to 25 patients treated with corticosteroid 
injections. They found 90% of patients treated surgically felt improvement whereas only 
20% of patients treated with injections felt improvement. This study however was not 
randomized and decision to treat operatively was made by the senior author leading to 
significant selection bias. 
 
Summary: 
Coccygodynia can be a functionally limiting and painful disease with conservative 
treatment providing mixed results. When proper surgical indications are met, results seem 
to be promising. However, there is a lack of data in the literature to support surgical 
treatment.  The case series reports currently in the literature are small and retrospective 
with ill-defined selection criteria. To date there has been no study prospectively 
following patients undergoing coccygectomy. This type of study could accurately obtain 
data prospectively.  This information will help better guide the clinician through 
treatment of this disease. 
 
Study Design 
A) Summary of Study Design: 
 
All patients will be seen and enrolled through an outpatient spine specialty clinic 
of the senior author.  Patients that meet the inclusion criteria will be offered 
enrollment in the study by a third party (clinical research assistant). Patients 
enrolled will then complete pre-treatment SF-36, Oswestry Disability Scale and a 
pain visual analog scale. Patients will be followed at 2 weeks, 6 weeks, 3 months, 
6 months,  1 year and 2 years after treatment.  Patients will complete the 

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questionnaire containing the VAS and tolerable sitting time at all visits with SF-
36 and Oswestry disability scale completed at one year post treatment.  
 
B) Type of Study:  Prospective Observational Study 
 
C) Study Population 
a. Inclusion Criteria 
i. Pain in the region of the coccyx 
ii. Pain for greater than 2 months 
iii. Tenderness to palpation over coccyx 
iv. Radiographic abnormalities of the coccyx 
1. Hypermobility of greater than 25 degrees, posterior 
subluxation of a mobile segment, or a coccygeal spicule 
on  sitting radiographs  
Or 
2. post-traumatic coccygodynia 
v. Failure of conservative treatment methods: 4 weeks of 
NSAIDS, seat cushion, and rest 
vi. Partial coccygectomy  
b. Exclusion Criteria 
i. Coexisting low back pain 
ii. Total previous coccyx surgery or previous lumbar fusion 
iii. Under 18 years of age 
 
c. Method of Selection: Patients will be deemed study candidates by the 
senior author. 
d. Sample’s representation of total population:  All subjects presenting 
to our specialty clinic that meet the selection criteria will be offered 
enrollment. This should represent the total population of patients with 
this disease. 
 
D) Definition of Variables  
a. Outcome Variables: Visual Analog Scale for pain intensity, Short-
Form 36, Oswestry Disability Scale, Tolerable sitting time, wound 
complications, intra-operative complications 
b. Independent Variables: Age, gender, co-morbidities, type of 
coccygeal morphology 
c. Potential Confounding Variables: Disability status, pain medications 
prescribed by other physicians, co-existing musculoskeletal disease. 
 
E) Methodology: 
a.Method of data collection:  A third party will meet with the patient at all data 
collection time points at the spine specialty clinic.        Those patients who do not return 
as scheduled will be contacted by phone at which time either a phone interview will be 
conducted or the questionnaire will be mailed to the patient for completion. 
 

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Coccygectomy 
The surgical procedure will be performed at a tertiary care center in an operating room 
suite. Pre-operatively, patients will complete a dulcolax suppository and will receive pre-
operative dose of first generation cephalosporin, vancomycin, or clindamycin for 
antibiotics.  Patients will be placed under general anesthesia and positioned in knee-to-
chest position. An incision will be made directly over the coccyx and cautery dissection 
will be used to identify the terminal mobile segment. The mobile segment will be 
removed and will be sent for pathology. The wound will be irrigated and closed in two 
layers with dermabond placed over the incision. Patients will be discharged home the day 
of surgery if appropriate. Postoperatively, patients will be placed on milk of magnesia 
and will sit in a donut cushion seat until seen at clinic follow-up two weeks post-
operatively.  
 
 
Visual Analog Pain Scale 
Visual analog scales (VAS) are one of the most frequently used measurement scales in 
health care research. A Visual Analogue Scale (Figure 3) is a measurement instrument 
that tries to measure a characteristic or attitude that is believed to range across a 
continuum of values and cannot easily be directly measured. For example, the amount of 
pain that a patient feels ranges across a continuum from none to an extreme amount of 
pain. From the patient's perspective this spectrum appears continuous ± their pain does 
not take discrete jumps, as a categorization of none, mild, moderate and severe would 
suggest. It was to capture this idea of an underlying continuum that the VAS was devised. 
Operationally a VAS is usually a horizontal line, 100 mm in length, anchored by word 
descriptors at each end, as illustrated in Fig. 3. The patient marks on the line the point 
that they feel represents their perception of their current state.  The VAS score is 
determined by measuring in millimeters from the left hand end of the line to the point that 
the patient marks.  There are many other ways in which VAS have been presented, 
including vertical lines and lines with extra descriptors.  As such an assessment is clearly 
highly subjective, these scales are of most value when looking at change within 
individuals, and are of less value for comparing across a group of individuals at one time 
point. It could be argued that a VAS is trying to produce interval/ratio data out of 
subjective values that are at best ordinal. Thus, some caution is required in handling such 
data. Many researchers prefer to use a method of analysis that is based on the rank 
ordering of scores rather than their exact values, to avoid reading too much into the 
precise VAS score. 
 
Short-Form 36 
A 36-item short-form (SF-36) was constructed to survey health status in the Medical 
Outcomes Study. The SF-36 (Figure 4) was designed for use in clinical practice and 
research, health policy evaluations, and general population surveys. The SF-36 includes 
one multi-item scale that assesses eight health concepts: 1) limitations in physical 
activities because of health problems; 2) limitations in social activities because of 
physical or emotional problems; 3) limitations in usual role activities because of physical 
health problems; 4) bodily pain; 5) general mental health (psychological distress and 

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well-being); 6) limitations in usual role activities because of emotional problems; 7) 
vitality (energy and fatigue); and 8) general health perceptions. 
 
Tolerable Sitting Time 
Patients will be asked how long they can sit before pain and discomfort forces them to 
stand. This data can help isolate the change in mechanical pain associated with 
coccygodynia following treatment. Patients will complete this item at every clinic visit 
(Figure 6). 
 
Oswestry Disability Scale 
The Oswestry Disability Index (ODI) has become one of the principal condition specific 
outcome measures used in the management of spinal disorders (Figure 5).  Fairbank et al 
confirmed its validity and reliability and is considered gold standard outcome measure 
(4).   
 
Radiographs 
Sitting and standing lateral radiographs will be obtained on all patients enrolled in the 
study. The Maigne criteria will be used to detect any abnormalities (figure 2).  
 
B) Control Patients: There will be no true control group.  
C) Projected study duration: 3 years. Patients will be enrolled for a two year 
period and all patients will have at least a 24 month follow-up. 
 
 
Statistical Procedures for Analysis and Sample Size Determination 
Standard statistical tests will be used.  Descriptive statistics including means and standard 
deviations, or counts and percentages will be reported.   As the scale of measurement for the 
VAS, SF-36, and the Oswestry Disability Scale are all on the ordinal scale, the Wilcoxon rank 
sum test will be used to compare the two groups (pre- and post-operative). Complication rates 
will be calculated.  
A p-value of less than 0.05 will be considered statistically significant.  The SAS software will  
be used for all analyses. 
Sample Size 
As the scale of measurement for the VAS, SF-36, and the Oswestry Disability Scale are all on 
the ordinal scale, the Wilcoxon rank sum test will be used to compare the two groups. The 
sample size for the Wilcoxon rank sum test was calculated using the formulas derived by 
Noether. Forty-four people are needed in each group to insure a power of 90%, with an alpha 
of 0.05, and p” = probability(Y>X) = 0.70 where Y and X are random samples from two 
populations.  Under the null hypothesis p” = 0.50.  To allow for lost to follow-up, fifty 
subjects will be recruited for each arm of the trial. 
Sample size is predicted to be achieved within two years, estimating a yearly enrollment 
of 50 patients 
 

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Feasibility of Project 
A) Time frame: 3 years 
B) Budget: 
a. Patients will be compensated $50 each for completion of the study- 
$5000.  Patients will be paid $20 at the first follow-up appointment 
and an additional $30 at the final follow-up if their data set is 
complete. 
b. SF-36 licensing fees: $500 for 2 years. 
c. Total- $5,500 
C) Available population: Senior author is a major referral physician for 
coccygodynia.  Expect to enroll 50 patients per year for 2 years.  Previous 
treatments will be recorded to further characterize the study population and to 
determine its applicability to the general population of patients with this 
condition. 
D) Equipment: none 
 

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References 
 
1. Balain B et al. Coccygectomy for Coccygodynia: Case Series and Review of 
Literature.  Spine. Vol31(13), 2006. pp414-420. 
 
2. Dennell L et al.  Coccygeal Retroversion.  Spine. Vol29(12), 2004. pp256-257. 
 
3. Doursounian L et al. Coccygectomy for Instability of the Coccyx. 
International Orthopaedics. Vol28, 2004. pp176-179. 
 
4. Fairbank JC, Pynsent PB.  The Oswestry Disability Index. Spine. Vol 25(22), 
2000.  pp2940-52. 
 
5. Fogel G et al. Coccygodynia: Evaluation and Management.  Journal of 
American Academy of Orthopaedic Surgeons. Volume 12, 2004. pp49-54. 
 
6. Hellberg S and Strange-Vognsen H.  Coccygodynia Treated by Resection of 
the Coccyx.  Acta Orthop Scand. Vol61(5), 1990. pp463-465. 
 
7. Maigne JY et al.  Instablility of the Coccyx in Coccygodynia.  Journal of 
Bone and Joint Surgery (British).  Volume 82(7), 2000. pp1038-1041. 
 
8. Pennekamp P et al. Coccygectomy for Coccygodynia: Does Pathogenesis 
Matter?  Journal of Trauma.  Vol59(6), 2005. pp1414-1419. 
 
9. Postacchini F, Massobrio M.  Idiopathic Coccygodynia.  J Bone Joint 
Surgery Am. 1983 (65). 
 
10. Wood, K,  Mehbod A. Operative Treatment for Coccygodynia.  Journal of 
Spinal Disorder Tech. Vol 17(6), 2004. pp511-515. 
 
11. Wray C et al.  Coccydynia. Aetiology and treatment. J Bone Joint Surg Br, 
Mar 1991; 73-B: 335 - 338. 
 
12. Noether, Gottfried E., “Sample Size Determination for Some Common 
Nonparametric Tests”. Journal of the American Statistical Association 1987; 
Vol. 82, No. 398, p. 647. 
 
 
 
 

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Figure 1 
 
 
 
 
 
Figure 2 
 
 
 
 
 
 
 
 
 

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Figure 3 
 
Visual Analog Scale 
 
 
No Pain 
 
 
 
 
 
Worst Possible Pain 
 
I 
 
 
 
 
 
 
 
I 
 
I 
 
 
 
 
 
 
 
I 
 
I 
 
 
 
 
 
 
 
I 
 
0 
 
 
 
 
 
 
 
100 
 
Figure 4 
 
SF-36  
 
1. In general, would you say your health is: 
 Excellent 
 Very good 
 Good 
 Fair 
 Poor 
 
2. Compared to one year ago, how would you rate your health in general now? 
 Much better now than a year ago 
 Somewhat better now than a year ago 
 About the same as one year ago 
 Somewhat worse now than one year ago 
 Much worse now than one year ago 
 
3. The following items are about activities you might do during a typical day. Does your health now limit you 
in these 
activities? If so, how much? 
 
a. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports. 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 
 
b. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf? 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 
 
c. Lifting or carrying groceries. 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 
 
d. Climbing several flights of stairs. 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 

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e. Climbing one flight of stairs. 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 
 
f. Bending, kneeling or stooping. 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 
 
g. Walking more than one mile. 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 
 
h. Walking several blocks. 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 
 
i. Walking one block. 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 
 
j. Bathing or dressing yourself. 
 Yes, limited a lot. 
 Yes, limited a little. 
 No, not limited at all. 
 
4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily 
activities as a 
result of your physical health? 
a. Cut down the amount of time you spent on work or other activities? 
 Yes  No 
b. Accomplished less than you would like? 
 Yes  No 
c. Were limited in the kind of work or other activities 
 Yes  No 
d. Had difficulty performing the work or other activities (for example, it took extra time) 
 Yes  No 
 
5. During the past 4 weeks, have you had any of the following problems with your work or other regular daily 
activities as a 
result of any emotional problems (such as feeling depressed or anxious)? 
a. Cut down the amount of time you spent on work or other activities? 
 Yes  No 
b. Accomplished less than you would like 
 Yes  No 
c. Didn't do work or other activities as carefully as usual 
 Yes  No 
 
6. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with 
your normal social 
activities with family, friends, neighbors, or groups? 
 Not at all 
 Slightly 
 Moderately 
 Quite a bit 
 Extremely 
 

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7. How much bodily pain have you had during the past 4 weeks? 
 Not at all 
 Slightly 
 Moderately 
 Quite a bit 
 Extremely 
 
8. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside 
the home and 
housework)? 
 Not at all 
 Slightly 
 Moderately 
 Quite a bit 
 Extremely 
 
9. These questions are about how you feel and how things have been with you during the past 4 weeks. For 
each question, 
please give the one answer that comes closest to the way you have been feeling. How much of the time 
during the past 4 
weeks. 
 
a. did you feel full of pep? 
 All of the time 
 Most of the time 
 A good bit of the time 
 Some of the time 
 A little of the time 
 None of the time 
 
b. have you been a very nervous person? 
 All of the time 
 Most of the time 
 A good bit of the time 
 Some of the time 
 A little of the time 
 None of the time 
 
c. have you felt so down in the dumps nothing could cheer you up? 
 All of the time 
 Most of the time 
 A good bit of the time 
 Some of the time 
 A little of the time 
 None of the time 
 
d. have you felt calm and peaceful? 
 All of the time 
 Most of the time 
 A good bit of the time 
 Some of the time 
 A little of the time 
 None of the time 
 
e. did you have a lot of energy? 
 All of the time 
 Most of the time 
 A good bit of the time 
 Some of the time 
 A little of the time 
 None of the time 
 

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f. have you felt downhearted and blue? 
 All of the time 
 Most of the time 
 A good bit of the time 
 Some of the time 
 A little of the time 
 None of the time 
 
g. did you feel worn out? 
 All of the time 
 Most of the time 
 A good bit of the time 
 Some of the time 
 A little of the time 
 None of the time 
 
h. have you been a happy person? 
 All of the time 
 Most of the time 
 A good bit of the time 
 Some of the time 
 A little of the time 
 None of the time 
 
i. did you feel tired? 
 All of the time 
 Most of the time 
 A good bit of the time 
 Some of the time 
 A little of the time 
 None of the time 
 
10. During the past 4 weeks, how much of the time has your physical health or emotional problems 
interfered with your 
social activities (like visiting friends, relatives, etc.)? 
 All of the time 
 Most of the time 
 Some of the time 
 A little of the time 
 None of the time 
 
11. How TRUE or FALSE is each of the following statements for you? 
 
a. I seem to get sick a little easier than other people 
 Definitely true 
 Mostly true 
 Don't know 
 Mostly false 
 Definitely false 
 
b. I am as healthy as anybody I know 
 Definitely true 
 Mostly true 
 Don't know 
 Mostly false 
 Definitely false 
 
c. I expect my health to get worse 
 Definitely true 
 Mostly true 
 Don't know 
 Mostly false 

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 Definitely false 
 
d. My health is excellent 
 Definitely true 
 Mostly true 
 Don't know 
 Mostly false 
 Definitely false 
 
Figure 5 
 
The Oswestry Disability Index (ODI) Version 2.0 or Oswestry Low Back Pain 
Disability Questionnaire 
Section 1: Pain Intensity  
• 
I can tolerate the pain I have without having to use pain killers. [0 points]  
• 
The pain is bad but I manage without taking pain killers. [1 point]  
• 
Pain killers give complete relief from pain . [2 points]  
• 
Pain killers give moderate relief from pain. [3 points ]  
• 
Pain killers give very little relief from pain. [4 points]  
• 
Pain killers have no effect on the pain and I do not use them. [5 points]  
Section 2: Personal Care  
• 
I can look after myself normally without causing extra pain. [0 points]  
• 
I can look after myself normally but it causes extra pain. [1 point]  
• 
It is painful to look after myself and I am slow and careful. [2 points]  
• 
I need some help but manage most of my personal care. [3 points]  
• 
I need help every day in most aspects of self care. [4 points]  
• 
I do not get dressed wash with difficulty and stay in bed. [5 points]  
  
Section 3: Lifting  
• 
I can lift heavy weights without extra pain. [0 points]  
• 
I can lift heavy weights but it gives extra pain. [1 point]  
• 
Pain prevents me from lifting heavy weights off the floor but I can manage if they are conveniently 
positioned for example on a table. [2 points]  
• 
Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are 
conveniently positioned. [3 points]  
• 
I can lift only very light weights. [4 points]  
• 
I cannot lift or carry anything at all. [5 points]  
Section 4: Walking  
• 
Pain does not prevent me walking any distance. [0 points]  
• 
Pain prevents me walking more than 1 mile. [1 point]  
• 
Pain prevents me walking more than 0.5 miles. [2 points]  
• 
Pain prevents me walking more than 0.25 miles. [3 points]  

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• 
I can only walk using a stick or crutches. [4 points]  
• 
I am in bed most of the time and have to crawl to the toilet. [5 points]  
Section 5: Sitting  
• 
I can sit in any chair as long as I like. [0 points]  
• 
I can only sit in my favorite chair as long as I like. [1 point]  
• 
Pain prevents me sitting more than 1 hour. [2 points]  
• 
Pain prevents me from sitting more than 0.5 hours. [3 points]  
• 
Pain prevents me from sitting more than 10 minutes. [4 points]  
• 
Pain prevents me from sitting at all. [5 points]  
Section 6: Standing  
• 
I can stand as long as I want without extra pain. [0 points]  
• 
I can stand as long as I want but it gives me extra pain. [1 point]  
• 
Pain prevents me from standing for more than 1 hour. [2 points]  
• 
Pain prevents me from standing for more than 30 minutes. [3 points]  
• 
Pain prevents me from standing for more than 10 minutes. [4 points]  
• 
Pain prevents me from standing at all. [5 points]  
Section 7: Sleeping  
• 
Pain does not prevent me from sleeping well. [0 points]  
• 
I can sleep well only by using tablets. [1 point]  
• 
Even when I take tablets I have less than 6 hours sleep. [2 points]  
• 
Even when I take tablets I have less than 4 hours sleep. [3 points]  
• 
Even when I take tablets I have less than 2 hours of sleep. [4 points]  
• 
Pain prevents me from sleeping at all. [5 points]  
Section 8: Sex Life  
• 
My sex life is normal and causes no extra pain. [0 points]  
• 
My sex life is normal but causes some extra pain. [1 point]  
• 
My sex life is nearly normal but is very painful. [2 points]  
• 
My sex life is severely restricted by pain. [3 points]  
• 
My sex life is nearly absent because of pain. [4 points]  
• 
Pain prevents any sex life at all. [5 points]  
Section 9: Social Life  
• 
My social life is normal and gives me no extra pain. [0 points]  
• 
My social life is normal but increases the degree of pain. [1 point]  
• 
Pain has no significant effect on my social life apart from limiting energetic interests such as dancing. [2 
points]  
• 
Pain has restricted my social life and I do not go out as often. [3 points]  
• 
Pain has restricted my social life to my home. [4 points]  
• 
I have no social life because of pain. [5 points]  
Section 10: Traveling  
• 
I can travel anywhere without extra pain. [0 points]  

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• 
I can travel anywhere but it gives me extra pain. [1 point]  
• 
Pain is bad but I manage journeys over 2 hours. [2 points]  
• 
Pain restricts me to journeys of less than 1 hour. [3 points]  
• 
Pain restricts me to short necessary journeys under 30 minutes. [4 points]  
• 
Pain prevents me from traveling except to the doctor or hospital. [5 points]  
  
Interpretation: 
ODI Scoring:  
• 
0% to 20% (minimal disability): Patients can cope with most activities of daily living. No treatment may be 
indicated except for suggestions on lifting, posture, physical fitness and diet. Patients with sedentary 
occupations (ex. secretaries) may experience more problems than others.  
• 
21%-40% (moderate disability): Patients may experience more pain and problems with sitting, lifting and 
standing. Travel and social life are more difficult. Patients may be off work. Personal care, sleeping and 
sexual activity may not be grossly affected. Conservative treatment may be sufficient.  
• 
41%-60% (severe disability): Pain is a primary problem for these patients, but they may also be 
experiencing significant problems in travel, personal care, social life, sexual activity and sleep. A detailed 
evaluation is appropriate.  
• 
61%-80% (crippled): Back pain has an impact on all aspects of daily living and work. Active treatment is 
required.  
• 
81%-100%: These patients may be bed bound or exaggerating their symptoms. Careful evaluation is 
recommended.  

Version 5 
05/17/2011 
Page 17 of 17 
Figure 6: Questionnaire 
Coccygodynia Questionnaire 
To be completed at enrollment, 2 weeks, 6 weeks, 3 months, 6 months and 1 year after 
treatment 
 
Date of Treatment __________ 
 
Pt name ______________________ 
Today’s Date ______________ 
 
MRN ________________________ 
 
1. Please draw a vertical mark (like this:   ) on the line below, which best describes the 
amount of pain you feel where your tailbone is or was. 
 
        No Pain  
 
 
 
                  Worst Possible Pain 
 
              0 
 
 
 
 
 
 
            100 
  
 
 
2. What medicines are you currently taking to control or treat pain at the site where your 
tailbone is or was?  Please include the dose and how often you take the medicine. 
 
 
 
 
 
3. Are you taking the medicines you have listed above in question 2 every day? 
For each medicine listed in your response to question 2, please write YES or NO. 
4. Please check the most appropriate box for you regarding sitting. 
 I can sit in any chair as long as I like.  
 I can only sit in my favorite chair as long as I like.  
 Pain prevents me from sitting more than 1 hour.  
 Pain prevents me from sitting more than 0.5 hours.  
 Pain prevents me from sitting more than 10 minutes.  
 Pain prevents me from sitting at all.