Effective pain management is crucial in oncological care, with opioids often serving as the cornerstone for controlling severe pain. Opioids are valued for their efcacy, versatility in administration, ease of titration, and ability to alleviate somatic, visceral, and neuropathic pain. However, balancing optimal analgesia with minimizing adverse effects and misuse risk is challenging. Comprehensive patient assessments, vigilant monitoring for misuse, and strategies to mitigate side effects like constipation, sedation, and respiratory depression are essential. Morphine, oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine each offer unique benets and challenges. Effective opioid use requires thorough patient assessment, careful opioid selection and dosing, and proactive side effect management.