Migraine and Headache Specialist and Doctors In Delhi

Headaches are a common health issue that affects people of all ages world over

Headaches are a common problem that affects people of all ages worldwide. There can be many reasons why people can develop headaches and these poor neck position while working or sleeping, stress, overwork, medical conditions such as degenerative disease of the spine, trauma, sinus problems, strokes, infections etc. Headaches which keep recurring are called recurrent headaches and those that tend to persist for a long period of time are called chronic headaches.

Headaches can hinder day to day activities and severely affect the quality of life especially in individuals who experience frequent severe headaches or long lasting / constant headaches . Recurrent headaches can be quite difficult to handle since they tend to develop suddenly, not giving you an opportunity to prepare for it and plan your day. There a variety of measures that you can take in order to reduce the impact and frequency of these headaches. Some of these are quite simple, but most people doubt the effectiveness and hence are hesitant to implement. These can work synergistically with the other management options suggested by your pain specialist. These include

General lifestyle modifications

• Regulating your sleep cycle: Having a regular sleep cycle goes a long way in helping to reduce these headaches. Good sleep environment plays an important role and includes a darkened bedroom, a quiet place where you are comfortable and it helps to unwind. Some find a relaxing hot bath helpful in unwinding prior to heading off to bed. It is advised to avoid watching TV, using laptops or mobiles before you go to bed.
• Hydration: Keep yourself well hydrated, because dehydration is a known trigger of headaches, and can worsen preexisting headaches.
• Regular meals: Have you meals on time. This another important factor that plays a role in the development of headaches. Low blood sugar/ hypoglycemia can trigger headaches. If you are in the habit of skipping meals or eating late and heavy meals, then you should consider changing this.
• Avoiding triggers: Other trigger/ precipitating factors may vary from individual to individual. From particular foods to the brightness of TV screens to loud noises, certain smells etc there are numerous factors. You are the best person to identify these and avoid them as much as possible.
• Tea and coffee: Minimize your intake of coffee and tea, because they are known to precipitate headaches. Avoid taking them late in the evenings and just before going to bed.
• Quit smoking
• Stress management and relaxation: Learn how to manage your stress in a productive manner and practice relaxation techniques.

These general measures, when used in combination with advice from your pain specialist can help you control your headaches better. Some of the common medical interventions used in management of headaches include:

Medications:

Medications for headache can be used to terminate the headache at the time you are experiencing it or can be taken as a preventive measure to reduce your chances of developing a headache. Preventive medications are usually taken when people experience frequent or continuous headaches, and they should be taken as prescribed by your doctor. Too much of any medication can also end up being the cause of your headache as well, and is given the name Medication Overuse Headache. The different medicines used for recurrent headaches are:

• Antidepressants: These medications, besides the pain relieving effects can also have other beneficial effects like reducing anxiety and sleep disturbances. The drug selected will depend on your individual situation.
• Beta blockers: Beta blockers, commonly used in management of high blood pressure and heart problems. They are helpful in the management of migraine related headaches
• Anti-seizure medicines: Several anti-seizure medicines help in the prevention different types of recurrent/ chronic headaches including migraine.
• NSAIDs: Nonsteroidal anti-inflammatory drugs are commonly used over the counter medications for mild to moderate pain, and they are effective in various different types of headaches. On frequent usage they can have harmful side effects such as gastritis and peptic ulcer disease; therefore they must be used with caution and under medical supervision.

Other interventional methods:

When simple measures such as lifestyle modifications and oral medications are not successful in resolving the headaches, then it may be worth considering other interventional methods. The intervention used will depend on the diagnosis. The common interventions include:

• Nerve blocks
• Injections of the cervical spine
• Radiofrequency treatment
• Botulinum toxin injections

Complementary & Alternative therapies

These include:

• Acupuncture – which involves the insertion of thin needles at definitive points in your body, with the intention of providing pain relief
• Massage therapy – this can help to reduce the stress and tension. It helps to relax the tightened muscles and thereby provides relief.
• Meditation and relaxation therapy
• Herbs and nutrients – Several organic herbs help in preventing migraine headaches and reduce the intensity of headaches. In deficiency states vitamin and mineral supplements can be taken to reduce headaches and prevent them from reoccurring.

It is best to seek medical advice before you starting with any of the above methods.

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Carpal Tunnel Syndrome (CTS) Treatment In Delhi

What is carpal tunnel syndrome?

Carpal tunnel syndrome or ‘median nerve compression’ is a painful condition that develops as a result of excess pressure on a nerve (median nerve) as it travels into the wrist through the narrow passageway.

Median nerve of arm carries sensation from thumb, index finger, middle finger and a part of the ring finger to the brain and controls the movement of some important hand muscle.  This nerve arises from the brachial plexus which is formed by the joining of many nerve roots exiting the spine in the neck region.  Median nerve runs down the forearm and passes through a narrow tunnel like passageway (carpal tunnel) on the palm side of the wrist. Your pain specialist can further explain the anatomical details to help you understand the condition better.

What causes carpal tunnel syndrome?

CTS may affect one or both hands. Those, who are involved in jobs requiring repetitive movement of the wrist such as construction workers, manufacturers etc. are more likely to be diagnosed with CTS. Women are three times more likely to have CTS and the prevalence, severity increases with age. Some studies have observed a peak incidence between the age of 45 and 59 years and a second peak between 75 and 84 years. In most cases it is difficult to pinpoint the cause as to why this condition develops although many predisposing factors have been identified and these include:

• Fluid retention from pregnancy especially in 3rd trimester
• Diabetes
• Thyroid dysfunction
• Obesity
• Autoimmune disorders such as rheumatoid arthritis
• Fractures or trauma to the wrist
• Repeated over extension of the wrist or movement such as typing, working on computers for more than 20 hours/ week
• Hereditary factors and conditions such as polyneuropathy (where multiple nerves are affected)

What are the symptoms of carpal tunnel syndrome?

In the early stage the symptoms may be intermittent and only at night.  As the condition advances these may become constant with development of wasting and weakness of hand muscles. The common symptoms include

• Numbness, burning, tingling, shock like sensation, pain in the ring, middle, index fingers and the thumb.
• Affected individuals often have disturbed sleep with urge to shake out their hand to obtain relief from symptoms.
• Provocation of symptoms by sustained hand or arm positions especially those involving arm elevation and wrist flexion as while holding a phone.  Provocation may also be more noticeable after repetitive actions of the hand or wrist.
• Clumsiness and weakness of hand with difficulty performing simple tasks like buttoning clothes & opening jars.
• Losing grip over things/ difficulty to hold objects firmly in hand due to weakness.
• Burning sensation/ pain may involve forearm, upper arm.

How is carpal tunnel syndrome diagnosed?

Your doctor will take a careful history and perform examination of your hand, arm, shoulders and neck. The sensation and movements of the hand may also be evaluated. The doctor may also hold, bend your wrist in a flexed position to check if this increases/ brings on your symptoms as this position further narrows the space for the nerve temporarily.

He/she may request for investigations such as electrodiagnostic studies (nerve conduction studies and electromyography) and ultrasound. Electrodiagnostic studies can help determine severity and prognosis. Plain X-ray may be useful if bone or joint disease/ structural abnormalities are suspected. Magnetic Resonance Imaging is useful in picking up rare pathological causes of CTS such as ganglion or bony deformity and these can have bearing on the surgical plan.

How is carpal tunnel syndrome treated?

Management of CTS depends on the severity of symptoms. In mild to moderate cases your doctor may recommend the conservative approach which should result in improvement in a few weeks time. This includes

Non-surgical methods

Splinting or bracing – Wearing a splint or brace will keep you from moving or bending the wrist while you rest. One study has shown that using a neutral wrist splint is twice as likely to give symptom relief compared to a splint in extension position. This modality, in combination with other treatment modalities, can be especially useful in pregnancy. However not everyone is able to get accustomed to the splint.

Physical therapy – There is some evidence that physical therapy techniques are effective CTS treatments. Multiple sessions from specialist physiotherapists and treatment modalities include carpal bone mobilization, therapeutic ultrasound and nerve glide exercises.

Oral medications – Oral steroids have shown to improve symptoms for limited time but are less effective than local injections with more side effects. Anti-inflammatory medications (NSAIDS) and diuretics have questionable benefits. Similarly  research studies show that vitamin B-6 supplementation has a negligible therapeutic effect.

Ultrasound-guided local injections

This involves injecting local anaesthetics and a small dose of steroid close to the problem site under ultrasound guidance. Ultrasound helps to ensure accuracy and minimises the risk of complications. One study has estimated the risk of serious complication with these injections as less than 0.1%.  There is evidence suggesting that the local injection is effective for more than one month in patients with mild to moderate carpal tunnel syndrome and delays the need for surgery at one year. Some studies have demonstrated improvement lasting 10 weeks to more than one year. This option can help manage the symptoms, avoiding the need for surgery. Certain cases may require a repeat injection for more effective symptom control. Wrist injections may help to relieve inflammation of the affected nerves and the fibrous sheath and fasten the healing process.

Surgical management

This option is suitable for patients with severe carpal tunnel syndrome or when symptoms have not improved after four to six months of conservative therapy. It is an effective option and can provide a lasting relief in 70 to 90 % of cases. The procedure involves release of pressure by placing a cut on the fibrous sheath, which will provide more space for the median nerve to pass through.

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How To Communicate Regarding Your Joint Pain To Your Pain Specialist In Delhi

Joint pain can be a source of prolonged discomfort which one may have to endure in life. This can affect your daily activities and make you feel depressed. Joint pain specialists in Delhi NCR are daily visited by numerous patients complaining of severe pain and in search of treatments which can provide quick relief.

For you to get the most appropriate treatment, the way you explain your pain to the doctor is important. There are a plethora of options for joint pain treatment in Delhi NCR . But reaching out to the right centre with experienced and skillful professionals whom you can count upon is important.

Read below to understand the importance of accurately describing your joint pain concerns to your treating doctor:

• Joint pain is subjective, without your explaining it may be very difficult for the doctor to know what your pain feels like and how severe it is
• Joint pain can have numerous causes such as like age related wear and tear, injury, trauma, infections etc
• Involvement of multiple joint in the body may require different assessment/investigations than just one isolated joint problem. Treatment options may also differ depending on the actual pathology
• Treatments offered depend on the severity of symptoms, their impact on your life, your age, activity levels and your goals/expectations. There are many treatment alternatives –both non-surgical and surgical, depending on the assessment of the above factors
• These are some important points which may help your doctor to understand and treat your pain better:

• Explain where the pain is; how long you have had the pain and how it started. If possible point the exact place, is it in the knee, ankle or shoulder pain?
• The character of pain can help in narrowing down the possible causes. For example is it aching, burning, shouting or stabbing pain? Is it present all the time?
• Aggravating or reliving factors are equally important- Is it worse when you are walking or at night time when you are trying to sleep. is it when you sit, walk or stand?
• It is important to tell the doctor how the pain affects your daily life. This information is essential as it enables the doctor to have a clear overview of what you are feeling. While describing the impact of pain do not forget about your sleep and mood.

In case the pain is short-term, your doctor may recommend home care like –

• Applying ice or hot compression at the joint several times.
• Avoiding activity that may cause the pain.
• Using a brace to protect the joint.

Various other options are used for Joint pain treatment in Delhi NCR like steroid or hyaluronic acid injections, nerve blocks and radiofrequency treatment. They can all help to ease the suffering and improve your quality of living. Some options are specific to the joints involved. These are mostly combined with medications and physiotherapy to improve outcomes.


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Dr. Amod Manocha Talks About Low Back Pain Treatment.mp4

Dr. Amod Manocha Talks About Low Back Pain Treatment.mp4

Managing Chronic Back Pain Treatment In Delhi

We have all endured finite episodes of severe pain whether that is a fractured bone or severe migraine or throes of labour pains. While we may be fortunate enough to remember them as distant memories, those with constant pain are often denied this luxury of forgetfulness. Their lives often encompassed around managing pain. Leaving aside the distress/agony it causes, it can cause other harmful effects on most body systems whether it is your mental/ emotional well being or your heart or your quality of life. Hence it is import to control it sooner rather than later.

Pain, although distressing, has the benefit of bringing medical problems to our attention. It usually abates as healing occurs. Chronic pain is pain that persists beyond the period of healing. Traditionally pain is thought to represent ongoing damage in body. This is now considered incorrect especially in context of longstanding/ chronic pain. To simplify- CHRONIC PAIN DOES NOT ALWAYS SIGNIFY ONGOING DAMAGE.

The newer understanding of chronic pain

In the past patients who usually complained of long standing pain, were often dismissed by healthcare professionals and most patients accepted pain as a part of ageing. In many cases it was not easy to figure out the underlying cause of pain, as chronic pain was not well understood. Over the years, with the amount of research that has gone into the study of chronic pain, doctors now understand more about different facets of pain management – physiological, psychological, pharmacological, interventional etc. There is enhanced understanding of mechanisms which can cause amplification of perceived pain symptoms. These advances and technological developments have enabled pain specialists to offer more to their patients. This stands true for back pain as well. While a significant number of people in a population suffer from back pain, fortunately for most this will resolve with time. However a small proportion does go on to develop chronic pain. The severity can vary from mild discomfort to debilitating illness interfering with activities of daily living and limiting functionality. Pain management specialists use a combination of modalities and specialties known as multimodal multidisciplinary approach to effectively manage the back pain.

What do you understand by pain management?

The complexities of pain and the fact that surgery or pills cannot resolve all pain has been long recognised. Understanding and treating chronic pain is challenging as we all experience and process pain differently. Hence one therapy does not work for all. This has lead to the development of Pain Medicine as a separate speciality. In this speciality the doctors are trained specially to deal chronic pain conditions and develop a better understanding of pain, underlying mechanisms and ways of reducing its impact on life.  A good pain physician focuses on holistic management of patient rather than just treating the disease.

Pain medicine is branch of medicine concerned with evaluation, treatment, and rehabilitation of persons in pain.  It utilises a Multi –disciplinary approach with specialists from different fields working together help in managing your pain, restore functioning and improving quality of life. The team mostly comprises of Pain Specialists, Specialist Nurses, Physiotherapists, Occupational therapists, Acupuncturists, Psychologists and Dieticians.

Role of pain management for chronic back pain

When it comes to chronic back pain, there are a variety of ways in which pain clinic can help.  Most pain clinic interventions have the advantage of being low risk, minimally invasive, non-surgical options without any need for prolonged hospitalisation. The treatment plan is individualised and may include a combination of the following

• Patient Education 
• Medication Management
• Physiotherapy and rehabilitation
• Psychology input including relaxation therapy, coping and self-management skills, cognitive behavioral therapy
• Complementary and alternative therapies including Acupuncture, TENS, acupressure, meditation
• Dietary advice
• Interventions such as injections. These can be especially useful for people where the source of pain is not known despite extensive investigations. Diagnostic injections can help in reliably identifying sources of pain when investigations have been inconclusive. Some of the treatment options are not commonly available elsewhere and these include 

• X-ray/ ultrasound  guided injections like nerve blocks, epidurals, facet joint injections
• CT guided interventions in areas which require precision for accuracy and minimising risks
• Advanced techniques such as Radiofrequency treatment which can provide prolonged pain relief for common conditions arthritis of the joints in the spine

Research and technological developments have opened new avenues in pain management such as 

• Newer technologies – cooled radiofrequency and spinal cord stimulators
• Regenerative medicine options including stem cells and platelet rich plasma(PRP)

Asa vast majority of patients with back pain do not require surgery, a combination of above mentioned modalities can help in effective pain relief.  Pain clinic is also an option for patients who have had inadequate results from previous surgery or those who are not keen on surgery or not fit to have surgery.

Consult Best Pain Specialist In Delhi, Dr. Amod Manocha.

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Pain Management in South Delhi describes about Pudendal Neuralgia/ Neuropathy Treatment In Delhi

What is Pudendal Neuralgia/ Neuropathy (PN)?

Pudendal nerve is one of the main nerves of the pelvis, with one nerve on each side. It runs from the lower back, along the pelvic floor to supply the genitals, lower part of rectum, and perineum (area between the sit bones). This nerve is closely involved with urinary and bowel functions.
Pudendal neuralgia is a condition related to irritation or damage of pudendal nerve, which presents as pain or altered sensation in the genital, rectal region or deep inside the pelvis. This condition can be very distressing, disabling, significantly impairing the quality of life. It is more common in women and is also addressed as cyclist syndrome, Alcock’s canal syndrome and pudendal nerve entrapment. Despite the significant advances in the evaluation and management of chronic pelvic pain in the past decade, it often goes unrecognised.
PN can be associated with other conditions such as Chronic Pelvic Pain Syndrome, dysfunctional voiding, painful bladder syndrome, chronic prostatitis etc. Due to the varied symptoms the patients may present to a number of different specialists including gynaecologists, urologists, colorectal surgeons, general surgeons, internal medicine specialists and neurologists.

What are the signs and symptoms of Pudendal Neuralgia?

The most common complaint is pelvic pain in the areas supplied by the pudendal nerve. Pain generally is

• Burning, shooting, electric shock like, crushing, aching, prickling or itching sensation
• Worse on sitting or exercising and resolves when lying flat (as during the night) or standing
• Better when sitting on the toilet seat
• Intermittent initially but can change to a constant pain with time
• It can radiate (travel) to buttocks (around ischial spines) and legs (inner thigh), feet

Other symptom which may be present include

• Urge to go to the toilet often (urinary frequency) or a feeling of a bladder infection, pain on passing urine
• Increased sensitivity in pelvic area
• Numbness, pins and needles sensation in pelvis
• Pain during sex or sexual arousal or orgasm/ ejaculation.
• It sometimes presents as persistent sexual arousal
• Foreign body/fullness sensation in rectum, vagina or perineum (like a tennis ball)
• Rectal pain with an urgent need to open the bowels

What causes Pudendal Neuralgia (PN)?

PN may arise as a result of

• Compression or entrapment of pudendal nerve (cycling, prolonged sitting, pelvic floor muscle spasm, any growth pressing on nerve or pressure on nerve as it emerges from below the piriformis muscle)
• Stretching of PN (childbirth, surgery)
• Direct Injury to pudendal nerve anywhere along its path (pelvic trauma, falls on the buttock or back, severe constipation)
• Compression at the level of spinal cord or nerve roots
• Biochemical injury from infections and diseases (diabetes, multiple sclerosis, viral infection- herpes zoster, HIV)

PN can be related to intense exercise of pelvic floor and neighbouring muscles such as during pelvic floor strengthening exercises, hip adductor exercises, cycling, weight lifting with squats, lunges, climbing stairs and those involving rapid flexion of the body at the trunk or hip flexion. Cycling can result in prolonged pressure on inner side of ischial tuberosity (sit bone) causing nerve compression.
Childbirth and the associated stretching of the nerve during delivery can be associated with the development of this condition. Some of the predisposing factors include prolonged second stage of labour, vaginal delivery requiring forceps assistance and previous pelvic floor injury.
Some gynaecological, colorectal, orthopaedic and urology surgical procedures can lead to pudendal neuralgia for example repair of pelvic organ prolapsed especially those involving mesh insertion and sacrospinous ligament fixation, hysterectomy, hip arthroscopy, orthopaedic procedures requiring traction, radical prostatectomy etc. Anatomical variations where the nerve travels though the ligaments rather that passing in-between them can also predispose to compression/ injury.

How is PN diagnosed?

PN can be challenging to diagnose as there are no specific tests. A combination of history, examination and investigations are used to diagnose PN. Most patients present with pain in the area supplied by the pudendal nerve, which worse on sitting. It generally worsens as the day goes on and resolves during the night.
Physical examination helps to confirm that the pain is in the area supplied by the nerve and helps to identify any altered sensations. Other neighbouring areas such as the lower spine, abdomen, sacrum, coccyx and the surrounding muscles including that of pelvic floor are also evaluated. Tenderness/ tingling on pressure on the inner side of sit bones (ischial tuberosity) or underneath the pubic bone may indicate a problem originating from the pudendal nerve.
Investigations are requested to support the diagnosis and rule out other conditions which may present similarly. They may include MRI scans, doppler ultrasound, pudendal nerve motor terminal latency (PNMTL). Advances in MRI including neurography now allow for good visualization of the pudendal nerve and its branches and in experienced hands can aid the process of diagnosis.
Resolution of pain a diagnostic nerve block, even if temporary, supports the diagnosis of pudendal neuralgia. These blocks also serve an important therapeutic role. Image guided blocks using fluoroscopy, ultrasound or CT scan is preferred.

How is PN treated?

Management of this condition requires active patient participation and use of a combination of lifestyle changes, medical interventions. Pudendal neuralgia can get worse if left untreated and early treatment may be more effective. Treatment includes

• Lifestyle changes are aimed at reducing the irritation of the nerve. These include avoiding activities which increase pain such as cycling, prolonged sitting etc, using a special cushion while sitting, avoiding constipation by food modification (increase fibre intake such as fresh fruit, vegetables, wholemeal breads and drink plenty of water etc.
• Neuropathic pain killers- these can help in reducing the pain
• Injections such as pudendal nerve block, pelvic flood muscle or tender point injections Often a series of injections are performed for maximal benefit.
• Pulsed radio-frequency treatment of the pudendal nerve, sacral nerve roots for pain modulation
• Supervised Physiotherapy aimed at the pelvic floor muscles. This can help with muscle spasms, imbalances and in correcting other dysfunctions
• Psychological support including cognitive behaviour therapy, meditation, mindfulness, self management and relaxation exercises
• For severe cases not responding to above measures, neuromodulation or pudendal nerve release surgery can be considered

For more information on Pudendal Nerve Block please refer to the patient information leaflet.

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Tailbone Pain Or Coccydynia Pain Treatment In Delhi

What is tailbone pain?

Tailbone pain or coccydynia is pain at the lower most aspect of the backbone called the coccyx. Coccyx is positioned at the very bottom of your spine, near the buttocks and is formed of 3 to 5 of fused bony segments. Its structure including length, angle of the curve and degree of mobility varies significantly between individuals. It was once believed to be remnant of the lost tail with no relevant function. Now we understand that it provides support for sitting and a place for attachment for various muscles, tendons, and ligaments.

What causes tailbone pain?

Trauma and falls are the most frequent cause of coccydynia. Trauma can lead to break, dislocation, subluxation or bruising of the coccyx and the surrounding area. Minor repeated trauma such as during prolonged periods of sitting on hard surfaces might often go unrecognized. Spasm of the pelvic floor muscles can pull on the coccyx and lead to pain. Rare causes of coccydynia include cancers and infection. Sometimes coccyx pain is referred from the spine.
Coccydynia is four or five times more common in women. Anatomical changes in the shape of pelvis, coccyx and childbirth may account for this. Some studies have found that it is more common in obese individuals.

Signs and symptoms of tail bone damage:

Most patients present with a dull ache, which changes to a sharp or throbbing pain with activities such as getting up from a sitting position or prolonged sitting. With time the severity and duration of pain can increase. Activities such as sexual intercourse and opening of bowels may become painful. The pain can radiate towards spine, legs and affect day-to-day activities.

When should I see doctor?

Tailbone pain is can be self-limiting and resolve on its own within few weeks to months. Those with moderate to severe pain interfering with daily activities and adversely affecting the quality of life should seek medical advice sooner. Other common reasons for medical consultation include – persisting pain despite conservative management, uncertain diagnosis, associated symptoms such as signs of infection or swelling etc.
The pain physician will take a complete history, and do an examination to narrow the possibilities. You may be asked to undergo investigations such as X-ray, CT or MRI scan to confirm diagnosis and rule out other conditions with similar presentation.

How is this condition managed?

There is variety of treatment options ranging from lifestyle modifications/ conservative management to injections. Simple measures that can help include

• Find an experienced pain physician/ doctor who can help you to confirm the diagnosis and treat the condition
• Avoid prolonged sitting especially on hard surfaces and bumpy rides as while travelling on in a car/ bus
• Modify your sitting posture to reduce pressure on coccyx such as leaning towards one side or leaning forwards while sitting. One should be careful with this as it can often place extra pressure on other areas leading to new pain symptoms.
• Using a doughnut-shaped or wedge (V-shaped) cushion while sitting
• When getting up from the sitting position do so slowly
• Avoiding aggravating factors such as constipation
• Appling heat or ice to the affected area
• Simple over-the-counter pain relievers
• Physical therapy. Aimed at pelvic floor relaxation techniques, postural retraining and stretching exercises

For severe or persisting pain the pain specialist may consider

• Medication. Stronger pain relief medications
• Injections. These are used to break the pain cycle and involve placement of local anaesthetic and steroids near the pain generator. Commonly performed injections include
• Injection of joint or ligaments surrounding the sacrum and coccyx such as the sacrococcygeal joint
• Ganglion Impar nerve block. Nerve blocks help to interrupt a nerve’s ability to transmit pain signals
• Manipulation. This can be used in combination with injection therapy or separately. Massaging the muscles attached to the tailbone might help in reducing pain
• Surgery. Surgical removal of coccyx is known as a coccygectomy. Because of the associated risks (infection, wound healing problems) and poor outcomes, this procedure is not commonly recommended/ used

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