Alexithymia, Pain Intensity, Quality of Life, and Psychological Symptoms in Chronic Coccydynia Patients Scheduled for Ganglion Impar Block

This is a single-center, prospective analytical cross-sectional observational study conducted at Marmara University Pendik Training and Research Hospital, Division of Algology, in collaboration with the Department of Psychiatry.

Ganglion Impar Block (GIB) is performed strictly for routine therapeutic indication and standard clinical practice; it is not an experimental intervention designed for this trial. No additional experimental interventions or post-procedural longitudinal follow-up evaluations are administered as part of the research protocol.

Following written voluntary informed consent, all study data are collected prospectively at a single pre-procedural time point immediately prior to the injection procedure. Assessment instruments completed by participants (taking approximately 25 to 35 minutes) include:

• Sociodemographic and Clinical Questionnaire: Age, gender, duration and characteristics of pain, educational level, employment, analgesics, and psychiatric history.
• 20-Item Toronto Alexithymia Scale (TAS-20): Assesses total alexithymia severity and its three subdimensions (Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally Oriented Thinking).
• Visual Analog Scale (VAS 0-10 cm): Evaluates subjective baseline pain intensity.
• Hospital Anxiety and Depression Scale (HADS): Assesses symptom severity for anxiety (HADS-A) and depression (HADS-D).
• 12-Item Short Form Health Survey (SF-12): Evaluates health-related quality of life summary components.
• Childhood Trauma Questionnaire (CTQ-33): Assesses retrospective self-reports of childhood maltreatment and neglect.

The study aims to analyze bivariate correlations among TAS-20 scores, pain intensity, quality of life, and affective symptoms, compare clinical profiles between alexithymic and non-alexithymic cohorts, and determine independent predictors of alexithymia severity using multivariable linear regression models.

Inclusion criteria

• Age 18 years or older.
• Clinical diagnosis of chronic coccydynia persisting for at least 3 months.
• Clinical indication and scheduled for Ganglion Impar Block due to persistent pain refractory to conservative treatments.
• Literate and possessing sufficient mental capacity to comprehend and complete self-report instruments.
• Provision of voluntary written informed consent.

Exclusion criteria

• Significant cognitive impairment or communication barriers impairing informed consent capacity or questionnaire completion.
• Active psychotic disorder or current manic episode.
• Suspected acute self-harm or suicidal risk identified during clinical evaluation.
• Chronic coccygeal pain secondary to malignancy, acute fractures, or active infection.
• Severe active psychiatric disease currently under medical treatment (e.g., severe mental illness, schizophrenia, bipolar affective disorder).

(Note: Depressive symptoms alone are not an exclusion criterion; they are assessed via HADS and controlled for as covariates in analytical models).