In Oncoguía del manejo del dolor en cáncer 2020 we present the epidemiology and the pathology scope caused by cancer pain, the World Health Organization’s analgesic ladder —and its subsequent adaptations—, the evaluation of the cancer-origin pain (that may be the result of the disease or be associated with the oncology treatment and that should include the complete clinical record and physical examination), and the use of the extension studies. Likewise, we addressed the pharmacological management based on the detailed multidimensional assessment of the pain severity, which starts at the appropriate level of the ladder for the pain degree and corresponds to the pharmacokinetics of the chosen drug. The use of opioids, coadjuvants, serotonin and noradrenaline uptake inhibitors, anticonvulsants, and N-Methyl D-Aspartate antagonists are also included. In the same way, we present the general guidelines and objectives for acute pain management and the medicare phases, as well as the primary interventionists management.