Intrathecal Therapy Versus Standard Care for Severe Cancer Pain

Inclusion Criteria: * Adult patients (≥18 years) with severe cancer refractory pain (all types of cancer), who have been receiving treatment with oral/systemic opioids for at least 4 weeks, and are expected to remain on opioids for the entire duration of the study. More than one opioid rotation has to be done before defining pain refractoriness. * Intrathecal therapy is recommended because of inefficacy or intolerance to strong systemic opioid treatment. Inefficacy is defined as mean daily visual analogue scale (VAS) pain intensity score at rest of ≥ 50 mm. Intolerance is defined as the occurrence of (S)AEs (even with dosage less than 200 mg/day of oral morphine equivalents) which prevents a further increase in the opioid dosage to obtain pain relief. * Patients suitable for IDD and with the ability to comply with the medical protocol and visits. * Survival prognosis of ≥ 6 months. Exclusion Criteria: * Patients with active, severe infection. * Patients with known brain metastases. * Patients with high risk of hemorrhaging. * Patients with respiratory depression (for use of morphine). * Patients with severe respiratory compromise; baseline oxygen SpO2 \< 90%, chronic CO2 retention. * Patients with severe cardiac disease or risk of cardiotoxicity (for use of bupivacaine). * Patients with severe liver impairment or liver failure (for use of ropivacaine). * Patients with allergies for medication or IDD hardware. * Pregnant or lactating women. * Women who plan to become pregnant within 1 month after the study.