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Background and Aims Chronic pain is a prevalent and therapeutically challenging symptom in cancer patients, often limited by intolerable side effects or inadequate response to conventional pain management strategies. Intrathecal drug delivery offers a targeted approach to pain management, potentially reducing systemic opioid requirements and associated side effects. There is a paucity of literature examining the efficacy of intrathecal pump (ITP) therapy in decreasing systemic opioid use. This retrospective review aims to assess the potential impact of ITP therapy on Morphine Equivalent Daily Dose (MEDD) in cancer patients with chronic pain.Methods A retrospective review was conducted on cancer patients at St. Paul’s Hospital in British Columbia, Canada, who received ITP therapy for chronic pain management between June 2022 and March 2024. Data regarding opioid use—including oral, subcutaneous, transdermal, and parenteral routes—were collected through chart review both prior to and approximately six months following ITP implantation. These opioid dosages were standardized and converted to oral Morphine Equivalent Daily Dose (MEDD). The primary analytical focus was on median MEDD, with the main outcome measure being the percent reduction in MEDD following therapy.Results A total of 18 patients received ITP therapy during the review time frame. 11 patients were included in the final analysis with 7 patients being excluded due to mortality prior to the 6-month postoperative time point or incomplete data. Raw data analysis revealed a significant reduction in MEDD following ITP therapy. The pre-implant median MEDD was 868.4 mg compared to 503.9 mg 6 months post-operatively, showing a 42% reduction in MEDD. 11% (2/18) of patients discontinued systemic opioids completely.Conclusions ITP therapy has the potential to improve chronic cancer pain and reduce systemic opioid requirements. These findings support the need for further research to evaluate the efficacy of ITP therapy in improving pain control and reducing systemic opioid requirements among diverse oncological patient populations.