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This review focuses on, but is not limited to, the 2 agents currently approved by the U.S. Food and Drug Administration for intrathecal analgesia: preservative\u2010free morphine and ziconotide (a nonopioid, selective N\u2010type calcium channel blocker). We describe the appropriate use of intrathecal therapy in the management of severe chronic pain, based on current best practices. Topics addressed here include patient selection, trialing, dosing and titration, adverse event profiles, long\u2010term management, intrathecal therapy for cancer\u2010related pain, and the placement of intrathecal therapy in the pain care algorithm. In appropriately selected patients with chronic pain, intrathecal therapy can provide substantial pain relief with improved functioning and quality of life. Successful long\u2010term management requires ongoing patient monitoring for changes in efficacy and the occurrence of adverse events, with subsequent changes in intrathecal dosing and titration, the addition of adjuvant intrathecal agents, and the use of concomitant oral medications to address side effects, as needed. Based on an infrequent but clinically concerning risk of overdose, granuloma, and other opioid\u2010induced complications, nonopioid therapy with ziconotide may be preferred as a first\u2010line intrathecal therapy in patients without a history of psychosis or allergy.<\/jats:p>","DOI":"10.1111\/papr.12438","type":"journal-article","created":{"date-parts":[[2016,2,26]],"date-time":"2016-02-26T01:53:57Z","timestamp":1456451637000},"page":"1092-1106","source":"Crossref","is-referenced-by-count":50,"title":["Clinical Uses of Intrathecal Therapy and Its Placement in the Pain Care Algorithm"],"prefix":"10.1111","volume":"16","author":[{"given":"Jason E.","family":"Pope","sequence":"first","affiliation":[{"name":"Summit Pain Alliance Santa Rosa California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy R.","family":"Deer","sequence":"additional","affiliation":[{"name":"Center for Pain Relief Charleston West Virginia 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