Abstract: Pain permeates the entire process of cancer, and its mechanism is complex, involving tumor microenvironment, cancer-related bone pain, cancer-related visceral pain, cancer-related neuropathic pain, and surgery and radiotherapy-related factors. Studies have indicated that lidocaine can alleviate intractable cancer pain for opioids, and its mechanism of action in treating various types of cancer pain may also be different, involving the regulation of acid-sensing ion channels (ASICS), transient receptor potential channels (TRP), voltage-gated sodium channels (VGSCs), nerve growth factor (NGF), glutamate and its receptors, inflammatory cells and cytokines, microglia, astrocytes, and high mobility group box 1 protein (HMGB1). This paper reviewed the mechanisms of cancer pain, the mechanisms of lidocaine in treating different types of cancer pain as well as its clinical applications.