Randomized controlled trials establish that many current treatment modalities can individually reduce cancer pain. These trials constitute about 1 percent of the published literature on cancer pain, enroll 1 in 10,000 patients at risk for cancer pain in developed countries, are often heterogeneous, and are often of poor methodologic quality. Many clinical questions remain unanswered and preclinical insights untranslated because of a lack of high-quality evidence. Age, gender, genetics, psychosocial context, and culture affect pain and analgesic efficacy. Multiple mechanisms of cancer pain exist. Despite the importance of pediatric cancer pain control, very few studies focus on children. High-quality trials are needed to advance progress in cancer pain relief.