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Background <p>Pain in carcinoma cervix is often managed as visceral pelvic pain. It includes systemic analgesics or use of standard interventions such as superior hypogastric plexus block.However, pelvic malignancies often produce mixed pain syndromes involving visceral,sympathetic, and somatic pathways. Identifying the dominant pain generator is important for effective pain management.</p> Case Presentation <p>We report a 52-year-old woman with locally advanced carcinoma cervix who presented to us with severe perianal and sacral pain refractory to opioid-based therapy. The pain was burning and pressure-like, aggravated by sitting, with defecation, with substantial functional limitation and sleep disturbance. He was taking 60 mg/day of oral morphine and adjuvant analgesics but pain intensity was 8/10 on the numerical rating scale. Clinically and on PETCT imaging, posterior tumour extension to the presacral and perirectal region was observed.This suggested the involvement of perineal sympathetic and sacral somatic pathways rather than isolated visceral pelvic pain. The patient underwent a fluoroscopy-guided ganglion impar block using a trans-sacrococcygeal approach with caudal epidural steroid injection.</p> Results <p>A significant improvement in pain was noted within 48 hours, with pain scores decreasing from 8/10 to 3/10. The patient reported improved sitting tolerance, better sleep, and enhanced daily functioning. Over the following two weeks, morphine effective daily dose [MEDD]reduced from 60 mg/day to 30 mg/day while maintaining satisfactory analgesia.</p> Conclusion <p>This case highlights the importance of mechanism based assessment in carcinoma cervix related pain. Posterior pelvic tumour extension can result in perineal and sacral pain patterns that are poorly managed by conventional visceral interventions alone. Targeted interventional techniques such as ganglion impar block and caudal epidural steroid injection can achieve significant symptom relief, decrease opioid requirement and improve quality of life in selected patients.</p>

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Mechanism-Based Interventional Pain Management in Carcinoma Cervix: Successful Use of Ganglion Impar Block and Caudal Epidural Steroid Injection—A Case Report

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Priti Kumar,
  • Devina Juneja,
  • Vikram Pratap Singh

摘要

Background

Pain in carcinoma cervix is often managed as visceral pelvic pain. It includes systemic analgesics or use of standard interventions such as superior hypogastric plexus block.However, pelvic malignancies often produce mixed pain syndromes involving visceral,sympathetic, and somatic pathways. Identifying the dominant pain generator is important for effective pain management.

Case Presentation

We report a 52-year-old woman with locally advanced carcinoma cervix who presented to us with severe perianal and sacral pain refractory to opioid-based therapy. The pain was burning and pressure-like, aggravated by sitting, with defecation, with substantial functional limitation and sleep disturbance. He was taking 60 mg/day of oral morphine and adjuvant analgesics but pain intensity was 8/10 on the numerical rating scale. Clinically and on PETCT imaging, posterior tumour extension to the presacral and perirectal region was observed.This suggested the involvement of perineal sympathetic and sacral somatic pathways rather than isolated visceral pelvic pain. The patient underwent a fluoroscopy-guided ganglion impar block using a trans-sacrococcygeal approach with caudal epidural steroid injection.

Results

A significant improvement in pain was noted within 48 hours, with pain scores decreasing from 8/10 to 3/10. The patient reported improved sitting tolerance, better sleep, and enhanced daily functioning. Over the following two weeks, morphine effective daily dose [MEDD]reduced from 60 mg/day to 30 mg/day while maintaining satisfactory analgesia.

Conclusion

This case highlights the importance of mechanism based assessment in carcinoma cervix related pain. Posterior pelvic tumour extension can result in perineal and sacral pain patterns that are poorly managed by conventional visceral interventions alone. Targeted interventional techniques such as ganglion impar block and caudal epidural steroid injection can achieve significant symptom relief, decrease opioid requirement and improve quality of life in selected patients.