Appropriate management of pain in patients with cancer is based on accurate syndrome diagnosis and judicious selection of therapeutic modalities. This article provides guidelines for the etiological and pathophysiological understanding of cancer pain syndromes and for ways of tailoring treatment to the specific diagnosis. Neuropathic and breakthrough pains are two of the more difficult syndromes that are addressed. Pharmacological choices, the mainstay of cancer pain treatment, are discussed with special attention to pharmacodynamics and to side effects. Drug treatment in the elderly, the medically ill, and the difficult patient are covered. Psychosocial issues and a palliative care program round out the care of the cancer patient with pain.