The ganglion impar is a solitary retroperitoneal
structure that marks the termination of paravertebral
sympathetic chains in the presacral space
and receives nociceptive inputs from pelvic
organs. Chronic perineal pain (CPP) in patients
with advanced cancer can be very debilitating.
Ganglion impar block can ameliorate CPP and
hence, improve quality of life.
Here, we describe the case of a 65-year-old
woman with a deformed coccyx caused by childhood
trauma and rectal resection from rectal
cancer who presented with CPP that substantially
affected her quality of life. She was unable to
tolerate the side effects of World Health Organization
Step 3 analgesics. The patient underwent
ganglion impar block that was challenging due to
anatomical abnormalities. There was significant
immediate and long-term improvement in quality
of life and disease coping in our patient after the
ganglion impar block. She was able to restore
physical activity, decrease the need for potent
opioids, and improve sleep quality.
We conclude that a ganglion impar block can
effectively treat CPP, and in palliative settings,
neurolytic ablation can be considered. It is often
challenging in patients with cancer due to anatomical
abnormalities. Further studies are needed
in patients with cancer who have CPP given the
suggestion of a better quality of life after ganglion
impar block.
Key words: Ganglion impar, chronic perineal
pain, quality of life, cancer pain, coccyx