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Background: Pelvic, perineal, and anorectal pain can be common findings in patients with Multiple Sclerosis (MS). These patients can develop bowel and bladder dysfunction with disease progression, as well as musculoskeletal component of their pain. The ganglion impar injection and radiofrequency ablation procedure are well-documented interventions to treat visceral pain arising from the pelvis as well as nociceptive pain from the anus and rectum. Case Report: We discuss the cases of two MS patients with significant disease progression who present with anorectal pain refractory to medical and surgical treatment. The ganglion impar block was offered to both of these patients with significant pain relief reported immediately and after several weeks. Conclusion: Ganglion impar block and radiofrequency ablation are safe and effective interventions for pelvic and perineal pain and can be beneficial for severe refractory anorectal pain in MS patients. Key words: Rectal pain, pelvic pain, perineal pain, Multiple Sclerosis, ganglion impar, interventional pain, radiofrequency ablation

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