Kowalski G, et al. - In this work, case series of two female patients diagnosed with colon and ovary cancer, respectively, who had very severe tenesmus pain (numerical rating scale 8–10) was reported. Treatment with high doses of opioids, including methadone with corticosteroids, anticonvulsants, antidepressants and ketamine, remained ineffective. The two patients were administered bupivacaine via a rectal enema. Outcomes revealed the achievement of safe and effective analgesia with administering 100 mg bupivacaine as a rectal enema. This procedure can be carried out in hospital departments and out-patient clinics. Furthermore, in the case of pain recurrence, repetition of this procedure can be done. Provision of effective pain relief usually allows time for tranferring patient to a specialized pain center.