The main advantage of intrathecal delivery therapy is targeted delivery of medication to the spinal cord with increased efficacy and diminished side effects compared with systemic analgesic medications. Intrathecal therapy has been found to be effective with decreased side effects and improved analgesia in 80% of cancer patients. The increased efficacy is due to the 100- to 300-fold increased potency of intrathecal medication compared with sys­temic medication. However, intrathecal therapy requires regular pump refills and may be complicated by rare adverse events including infections, catheter or pump malfunctions requiring surgical revision, or development of catheter tip granulomas, potentially leading to inade­quate analgesia or neurologic deficits. Pump batteries may last from 5 years to 10 years depending on usage. Fatali­ties surrounding intrathecal therapy have been linked to respiratory depression when high doses and high cervical catheters are used or when combined with high systemic doses of medications; patients must be monitored for respiratory depression or sedation when initiating or increasing intrathecal therapeutic agents. Some intrathe­cal pumps need to be emptied prior to MRI; due to the magnetic forces of the MRI, the entirety of the drug res­ervoir could inadvertently open. Therefore, it is critical that the type of pump is known prior to placing the patient and pump in an MRI machine. Additionally, anti­coagulants and NSAIDs need to be stopped prior to pump implantation and need to be held briefly after the implan­tation as well; this temporary cessation imposes the risk of potentially causing blood clots.