OBJECTIVES To describe barriers to optimal cancer pain management, activities that have been implemented in recent years to partially overcome these barriers, and the importance of the pharmacist's role in the cancer pain management process. SUMMARY Cancer pain management remains a formidable challenge. Barriers in the United States include inadequate provider training; patients' reluctance to report pain; and deficiencies within the health care infrastructure, such as restrictive regulation of controlled substances and inadequate insurance coverage. Despite these barriers, recent efforts have raised awareness of the gap between suboptimal and optimal cancer pain management. These include: the development of guidelines (and the conduct of scientific studies) to educate providers about pain management or gaps in the cancer pain management process; regulation that has lessened provider restrictions in prescribing analgesics; the emergence of patient and provider advocacy groups; and the development of pain assessment instruments. Because of their clinical and pharmacologic expertise, pharmacists are crucial to the shaping and success of cancer pain management strategies in the United States today. CONCLUSION Despite its high prevalence and the increasing awareness of the effects of pain on quality of life, cancer pain management remains secondary to treatment of the disease itself. Refining the cancer pain management process in the United States will depend on continued education and emphasis on pain assessment and a proactive approach to pain management, provider groups' effective collaboration with each other and with patients, and overcoming legal, regulatory, and cost barriers.