The efficacy of spinal opioids is well known, the analgesia is potent and long lasting, due to the central localization of the opioid receptors. The analgesia is intimately related to the inhibition of the nociceptive signal in the spinal cord but side effects are mainly mediated by the activation of the mu opioid receptor in the brain and the brain stem. Only a limited number of controlled clinical studies compared systemic versus spinal administration of morphine in chronic pain patients, and the real benefit for the intrathecal route remains controversial. Implanted devices for a continuous intrathecal delivery of opioids should be prescribed only to patients with intractable chronic pain for which conventional methods were previously ineffective.