The aim of this survey was to determine the prescribing patterns of German physicians in the treatment of cancer pain. The computerized patient records of 330 practices, which treated a total number of 1,104,435 patients over a 3-year period, were analyzed. "Strong" opioids, widely accepted in the management of severe cancer pain, were prescribed to just 322 of 16,630 cancer patients (1.9%). Only 99 (0.6%) patients received more than three prescriptions during more than 3 weeks of treatment. Additionally, many prescriptions mandated inadequate time intervals for the dosing, and 12% of the prescriptions were given "as required." From these data, it can be concluded that the majority of cancer patients in Germany are not treated for pain at all, and that those patients who receive treatment are treated inadequately. Germany is still a developing country in terms of pain therapy. This situation is symptomatic of many countries and reflects the continuing prejudice against opioids.