Abstract: The management of refractory cancer pain remains a challenge for oncologists and pain physicians worldwide. Although a large number of patients with cancer pain benefit from oral analgesics in the early stages, single oral opioids tend to be less effective in patients with the advanced disease and refractory cancer pain; for this, intravenous opioid administration is the most commonly used rapid analgesic option. Currently, the increasing clinical use of opioid-patient controlled intravenous analgesia (PCIA) has generated extensive discussion on its indications, drug selection, titration, and other related topics. In addition, with the rapid development of multimodal analgesia, the individualized measures for cancer pain management show a broader exploratory scope. We will review the above topics in this article with the hope of providing some references for treatment optimization in refractory cancer pain management.