Pain is a common symptom in patients with cancer. Up to two thirds of patients with cancer experience pain that requires a strong opioid for pain relief. Cancer pain management can be challenging as the pain experience differs among patients. A patient’s response to opioids and other analgesia depends on several factors such as the character and cause of pain, and the pharmacodynamics and pharmacokinetics of the drug. Optimizing pain control is important, as pain can impact negatively on many aspects of a patient’s life such as mood, sleep, social interactions, cognition and physical function, resulting in physical, emotional and existential suffering. We will use the following case study to illustrate the process of pain assessment and the importance of understanding the aetiology of the pain in a patient with cancer. We will also discuss the pharmacological and non-pharmacological management of cancer pain.