Treatments that may have direct central neuromodulatory effects can offer significant benefits for the appropriately selected patient. Intrathecal therapy should significantly improve functional status and decrease use of oral analgesic requirement. Patient selection is critical to the successful outcome when considering this therapy. Both cancer and chronic nonneuropathic pain as well as neuropathic pain may benefit from intrathecal therapy. This course addresses benefits and limitations, speaks to the importance of patients’ expectations and how they should be reviewed prior to entering into an intrathecal trial of opiates or ziconotide.