With worsening drug epidemics in the United States, proper pharmacological management in patients with chronic pelvic pain has very significant consequences. It includes chronic management of those patients as well as perioperative management. Multiple nonnarcotic medications have been shown to be very effective in managing patients with pelvic pain. The mainstay of treatment remains nonsteroidal anti-inflammatory medications. They are effective in any type of pain but particularly in dysmenorrhea and inflammatory pain. Anticonvulsants such as gabapentin have been shown to be effective in neuropathic type of pain as well as pre- and postoperative management. Many patients with pelvic pain develop significant pelvic floor muscle spasm. They do not appear to respond well to oral muscle relaxants but usually have very good responses to vaginal suppositories with various combinations of diazepam and other medications. In patients who do not respond to muscle relaxants botulinum toxin injections to pelvic floor muscles may provide muscle relaxation and therefore pain relief. Patients with pain related to nerves may respond to gabapentin and pregabalin but also benefit from use of lidocaine patches. Narcotics pain medications should be used very cautiously and as a last resort.