Addressing cancer pain requires real analysis and reflection. Successful management of pain through medical therapy requires a balance between effective analgesia and good tolerability, which is often difficult to achieve with conventional opioids. Treatment with tapentadol for oncologic pain results in successful pain relief, good tolerability and improvement in overall quality of life. This indicates that it is also a therapeutic option in pain of oncological origin. The combination of two mechanisms of action, which interact synergistically to produce analgesia, is a promising approach to generate effective analgesics. Tapentadol combines the agonistic activity of the μ opioid receptor (MOR) with the inhibition of noradrenaline reuptake (NRI) and thus provides highly effective analgesia comparable to strong opioids, but with favorable tolerability.