Currently, opioid analgesics are the first line of treatment for severe pain management in postoperative and oncologic patients. Nevertheless, due to several side effects are consider as high risk drugs. For this, it is important to implement protocols and algorithms for its rational use, focused on improving safety in prescription, dispensing, administration, vigilance and follow-up of these analgesics. All professionals in hospital environment, specially physicians and nurses, must possess the knowledge for ideal management of opioid analgesics and its possible side effects, to improve patient safety in accordance with pain free hospital institutional policy. This protocol is directed to treated patients at Clinica Universitaria Colombia, that are hospitalized or in ambulatory care, with acute or chronic pain, from oncologic and non-oncologic etiology that need strong opioids for symptomatic control. Pharmacological management it is adjusted to this institution characteristics considering resources availability and following the guidelines of pain and palliative care program.