This study examines retrospectively the natural history, classification, clinical and pathological features and results of treatment of intractable pain associated with lung cancer in 221 patients. The 3 chief causes of malignancy-related pain were skeletal metastatic disease (34%), Pancoast's tumour (31%) and chest wall disease (21%), together comprising 78% of the cancer-related pain problems. The median interval between cancer diagnosis and pain onset was 1 month. Overall pathological types of cancer were similar to those of lung cancer in general. Treatment modalities were varied and included radiation, percutaneous cordotomy, regional deafferentation and pharmacotherapy. The median survival from pain onset was 10 months.