This cross-sectional study aimed to investigate cancer patients' cognitive level of pain control and to evaluate the patient-related factors or barriers to effective cancer pain management in China. In seven tertiary hospitals across China, 372 patients experiencing cancer pain were surveyed through a self-designed questionnaire to assess the factors associated with effective pain control. Patients' demographic data and pain control-related factors were recorded. Cluster sampling and binary logistic regression models were used to investigate the association between predictive factors and effective pain control. The survey showed that the majority of the patients were more than 45 years old (76.3%), and 64.4% had an average annual income of more than 20 000 RMB. One-third of the patients suffered from cancer pain for more than 3 months, and 75.1% received professional guidance during medication. The barriers to pain control for patients included preference to enduring pain and refusing analgesics (62.9%), negligence towards drug usage (28.5%), concerns about the addiction (48.2%) and adverse reaction (56.4%). The average annual family income, professional guidance, knowledge of pain medication, adherence to analgesics, and concerns about addiction to analgesics were significantly correlated to the effect of patients' pain control. The study presents major barriers to optimal pain control among patients with cancer in China. Our findings suggest that educational programs and medical insurance reimbursement support from the government are urgently needed to overcome the cognitive barriers toward effective pain management and to relieve the economic burden among patients with cancer pain in China.