Implantable spinal infusion devices with increasing sophistication in design have been available for the last 2 decades. Initially introduced as a way to treat severe cancer pain, indications for spinal infusion pumps have been expanded to include nonmalignant pain and spasticity. This report describes criteria for patient selection and details several paradigms for conducting prognostic trials. Surgical considerations for implantation and techniques to decrease failure rates are reviewed. Surgical complications such as bleeding, seroma, infection, and cerebrospinal fluid leak are explored, and treatment options are discussed. Copyright © 2000 by W.B. Saunders Company