The Pain Medicine Division is offering neuroaxial opioid trials, placement of permanent pumps and catheters, and follow-up dosing and refill service to selected patients from our pain practice and others by referral. Our protocol for these patients will be as follows:

1. The Pain physician will conduct the neuroaxial opioid trials in the hospital, with appropriate monitoring. He/she will titrate the trial with PCA iv medications based on the patient's activity level and pain and adjust the neuroaxial infusion accordingly.

2. Whenever possible, the patient will be discharged with the approximate opioid dose calculated and readmitted for the definitive elective procedure at a later time. However for an urgent pain patient, i.e. refractory cancer pain, we will implant the pump and catheter on the same admission.

3. The pain physician will be solely responsible for all pain medications during the trial, implant admission, and follow up pump medication. He/she will also write the orders to pharmacy for the epidural and intrathecal medications. Long-term management of pain medications will be arranged between the pain physician and the referring physician.

4. Follow-up infusion titrations will be by the pain physician at his/her outpatient clinical site with back up by surgical colleague who will primarily be consulted in cases of surgical complications or wound care.

5. Pain fellows who are either on call or responsible for the patient during their trial and procedure admission will be involved in total patient care, including scrubbing on the cases and post operative follow-up care.

6. Dictation and billing will be divided among the attending physicians with pain physician dictating and charging for intrathecal catheter, tunnelling and dosing, and co-surgeon charging for preparation of sc pocket, and any other pocket revisions that may be necessary.

7. On-call Pain Fellows will be available for dose titrations and refills on our inpatients. Other implanting physicians will be responsible for their patients' titrations and refills. The nurse in the hospital can do simple interrogations and simple rate adjustments with specific directions from the responsible physician.