I had an intrathecal pain pump removed after 18 years ( that's a story for another time). During that time many adjustments were needed. After getting the correct strength of the correct chemical and the correct machine adjustments, among other considerations, the pain relief was wonderful. Many on this forum have not gotten the pain relief expected or predicted and their providers only increased the narcotic, with apparently little results! Since that seems to be the case. perhaps another very important aspect hasn't been considered-that of the catheter placement. Some main benefits of an implanted pain pump are that (if correctly installed); #1-it can supply a much higher dosage than oral dosing, #2- the narcotic goes directly to the pain area which allows for much, much less side effects, I was clear headed, no constipation etc. This is because most of the narcotic goes directly to the pain source area and does not go systemic. Morphine is so powerful that an increased dosage should provide at least some amelioration unless the morphine is delivered to an area that is not the source of the pain. So catheter placement is extremely important and should be suspect if the pain is not reduced at least somewhat at higher dosing or the initial test for pump implantation resulted in tangible relief.