Pelvic pain

Abstract Pelvic pain arising from urogenital, gynaecological, and colorectal malignancy is often debilitating and causes additional distress due to involvement of autonomic functions. Management of pain in these patients can be challenging as there is the also quite a lot of psychological distress due to the impact of the disease as well as the neuropathic pain due to tumour involvement of nerve plexuses and bony metastasis. Pain management is best addressed using a multimodal strategy with appropriate pharmacology, pain interventions, and psychological support at various stages of disease. Blockade of the sympathetic nervous system at the superior or inferior hypogastric plexus and ganglion impar for visceral pain as well as the lumbosacral roots for somatic pain have been used effectively to optimize pain control, decrease opioid requirements and side effects, and improve quality of life. In refractory cases patients may require percutaneous cordotomy or indwelling catheters to deliver intrathecal opioids. This chapter discusses the pain management during the journey of a patient with pelvic malignancy.