Pain is a common complication due to malignancies and cancer related treatments, more than half of cancer patients has suffered from this unpleasant complication. Clinical treatment of cancer related pain has followed the 3-ladder principle formulated by the World Health Organization for several decades. However, this principle may have some disadvantages including; inability to alleviate pain promptly, inadequate route of drug administration and increasing the risk of elevating the severity of the side effects of medications. The new concept of pain control in cancer patients that regards low dose of strong opioids as 2nd -- ladder medications, should be able to improve these disadvantages. But the adverse effects of opioids ought to be managed aggressively in order to increase patient’s adherence of treatment and alleviate cancer related pain successfully.