The aim of the study was to assess the appropriateness of pain management in cancer patients by determining the modalities of pain treatment currently provided to cancer patients, comparing this treatment to existing guideline on control of pain in patients with cancer and identifying areas of inappropriate prescribing. A prospective observational study was carried out in the oncology unit at tertiary-care teaching hospital in Riyadh, Saudi Arabia over a period from May-October 2006 included all adult cancer patients. Of 160 patients participated in the study, 80 (50%) reported moderate or severe pain. 40% of those with pain were not given any pain medication. Sixty percent of the patients had appropriate pain management. Pain documentation was inappropriate and needs improvement in 57% of the patients. There was under utilization of NSAIDs which were prescribed in 8 (5%) patients only from those on pain medication. Transdermal fentanyl was the most frequently used opioid (21%) for moderate to severe pain. Therefore, despite published guidelines for pain management, many patients with cancer receive inadequate analgesia.