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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims Advances in cancer survival rates have shifted pain management strategies from short-term to long-term approaches, emphasizing chronic pain control. Intrathecal (IT) therapy delivers sustained analgesia, minimizes systemic side effects, and can significantly improve the quality of life in patients with refractory cancer pain and has been widely used.Methods A 71-year-old woman with metastatic ocular malignant melanoma and urothelial carcinoma presented with severe refractory nociceptive and neuropathic pain (VAS 8) caused by osteolytic metastases in her spine, radiating to her abdomen and lower extremities, and resistant to multimodal approach using high-dose opioids and non-opioid analgesics, neuropathic pain medications, and adjuvants, administered through various routes. The pump was surgically implanted and a catheter was inserted to level Th 9, initially delivering 1 mg/day morphine and 6 mg/day bupivacaine intrathecally. Within three days, her pain improved to VAS 3, with enhanced quality of life as measured by validated questionnaires. Dose adjustments were made based on disease progression: after three months, clonidine (65 mcg/day) was added, with increased doses of morphine (2.6 mg/day) and bupivacaine (19.5 mg/day). Pain control stabilized at VAS 3 without significant side effects, and symptoms like constipation and dizziness diminished. The patient passed away peacefully six months post-intervention.Results Intrathecal drug delivery directly into the cerebrospinal fluid bypasses the blood-brain barrier, enabling lower drug doses than systemic routes while maintaining effective analgesia. Using implantable IT pumps represents an advantage compared to traditional intrathecal therapy methods, exhibiting a long-term efficacy for refractory cancer pain treatment, reduced infection risks, reduced caregiver burden, enhanced safety, and improved patient quality of life.Conclusions Intrathecal therapy using an implantable pump provided effective pain relief and improved quality of life for a patient with refractory cancer pain. This first case in Slovenia marks a significant step toward integrating IT therapy using implantable pumps into standard palliative care.