Over the past decade, there has been a surge of literature related to disparities in pain treatment between minority and nonminority patients. Conspicuously lacking from this body of literature is an effort to investigate the patient-level factors that might account for undertreatment of pain among minorities. The present qualitative descriptive study was designed to gain a preliminary understanding of the preference for analgesic treatment for cancer pain among African Americans and the factors shaping these preferences. The sample (n ¼ 35) was recruited from three outpatient oncology clinics in the Mid-Atlantic region. Inclusion was based on selfidentified African Americans,>18 years of age, diagnosed with solid tumors, with self-reported cancer pain of at least one month, and no history of major surgery in the past three months. The data were gathered using demographics, the Brief Pain Inventory-Long Form, and in-depth semistructured interviews. Qualitative findings revealed that despite having overt access to pain medications, considerable intra-ethnic heterogeneity existed in the preference for analgesia among this group of African Americans. The subjective preference for analgesics for cancer pain was tied to a number of covert factors such as meaning of cancer pain treatment, past experience with pain relief and analgesic side effects, fears of dependency and tolerance, and past experience with providers and the health system. These factors should be the focus of future inquiry.