My brother was offered an intrathecal pain pump for germ cell cancer with mets in his pelvis, back, spine, lung, and liver. what are pros and cons?

Pain relief: Sorry to hear you brother is so sick. The pump is a good alternative as it will provide constant and measured pain relief. Risks are mostly associated with the actual process of implantation (any surgical procedure has risks like infection, pain, etc.). Discuss with his physicians your concerns.

Intrathecal pump: He has nothing to lose. It is an efficient way of pain control using a much lesser amount of narcotic compared to other means of administration.

I am sorry that : Your brother has to deal with this problem. An intrathecal pump can manage his pain more effectively than less invasive measures. It is an invasive procedure, however, so it is reserved for people like your brother and not appropriate for everyone.