Intrathecal Opioids for Chronic Pain:

The first implanted fixed rate pumps were used in humans in the mid-1980s [1]. In 1991, Medtronic ® released the first programmable pump for human use [2]. The majority of the research and reports concern programmable pumps, and the best and most current systematic review of the literature only identified manuscripts on these devices, and only considered chronic nonmalignant pain (AKA chronic noncancer pain [CNCP]) [1]. Older reviews are available [3–5]. No review, nor our literature search, identified a randomized controlled trial (RCT) of implant-able pumps using opioids in CNCP; yet despite such lack of evidence, the devices are commonly used for patients with CNCP. In contrast, there is a Food and Drug Admin-istration drug registry of RCTs available for implantable pumps using ziconotide in CNCP [6]; Intrathecal (IT