Cancer pain of moderate intensity (5-6 on a numeric scale from 0 to 10) is usually treated with weak opioids according to the conventional analgesic ladder strategy. The aim of our study was to compare the conventional strategy (sequential drug approach: arm A) with an innovative one passing from step 1 to step 3 of the analgesic ladder (arm B). To date 42 evaluable patients aged 18 years or older with multiple viscera or bone metastases, or with locally advanced disease have been enrolled onto the study (arm A: 16, arm B: 26). Pain intensity was assessed over a period of 1703 days of pain therapy (arm A: 789 days; arm B: 914 days) using a 0-10 numeric rating scale (NRS) based on selected questions of the validated Italian version of the Brief Pain Inventory. Treatment-specific variables (efficacy, side-effects, adjuvant agents) were recorded at baseline to a maximum follow-up of 90 days per patient. The number of days in each arm was recorded, together with the level of pain and other symptoms and side-effects reported by the patients. The passage through the second step seemed to involve a larger use of adjuvant agents. A direct jump to step 3 resulted in fewer days with a "worst pain" equal to or higher than 5. Constipation was more frequently reported in the innovative strategy where, however, prophylactic laxative therapy was used less. Our preliminary data would seem to suggest that a direct move to the third step may be feasible and could reduce some pain scores, but also requires careful management of side-effects.