Cancer pain remains prevalent and severe for many patients, particularly in those with advanced disease before they die. The effectiveness of treatment in routine practice appears to have changed little in the last 30 years since publication of the WHO approach.Qualitative studies in patients with advanced cancer suggest that key priorities in pain management strategies should be to help patients achieve a balance between pain and adverse effects of analgesia in order to optimise physical function, and support for selfmanagement.Interventions targeted at physiological, behavioural and health-system mechanisms can improve pain outcomes for patients. Strong opioids have medium to strong effect sizes while most other drug and non-drug interventions have small to medium effect sizes at best. The limitations of current analgesic interventions should encourage greater use of interventions that target patient and healthcare professional behaviour. A framework is proposed for interventions in cancer pain management that target mechanisms and outcomes that are important to patients. This framework might help to broaden management strategies and encourage evidence-based but underused interventions.3