Tumors originating from or involving the spine are often associated with significant pain. The pain can be debilitating and can impact a patient’s quality of life or ability to engage with treatment and rehabilitation. The purpose of this chapter is to review the incidence and pathophysiology of malignant pain, relevant neuroanatomy, medical management of oncologic pain, and the most widely-utilized interventional options. The goal is to provide an overview of the known mechanisms of pain and to review available evidence for interventional procedures as they relate to pain from spine tumors. A special focus is made on intrathecal drug delivery systems and options for neuromodulation as they relate to oncologic pain.