Tapentadol, mu receptor agonist (MOR) and noradrenaline reuptake inhibitor (NRI), is the first drug in novel class of centrally acting analgetics (MOR-NRI). Both mechanisms are considered to contribute synergistically to the analgesic efficacy and reducing typical opioid side effects (especially gastrointestinal symptoms, e.g. constipation, nausea, vomiting or central nervous system disorders). The author presented case reports of two patients with severe nociceptive-neuropathic cancer pain (bone pain and chemotherapy induced pain) treated with tapentadol PR. In both cases tapentadol PR in daily doses up to 200 mg proved to be very efficient and safe, including the combination with morphine CR. The tapentadol treatment remained effective and well-tolerated for several months observation.