Effective pain management in palliative care must be accompanied by pain assessment. The study examined the utility of Russian version of Brief Pain Inventory BPI-R among Russian patients for estimating Pain Management Index (PMI) and identifying negative PMI predictors. The study included 120 advanced cancer patients with pain (38% males, 62% females, mean age 62). Patients completed BPI-R. PMI is calculated by subtracting the index of pain severity from the value of analgesic power. Negative PMI values mean inadequate pain management. The possible predictors of inadequate pain management were studied: education, discrepancy of ratings between the physician and patient, ECOG PS, and age. The mean pain severity in the patient sample according to the BPI-R was 4.8 (SD=2.0). We found that 17% of patients had severe pain (7-10), 37% had moderate pain (5-6), and 46% had mild pain (4 or less). The mean of interference items was 3.3 (SD=1.9). Negative PMI occurred for 66% (n=79) of patients, including 4% with PMI of ?3, 20% with ? 2, 42% with ?1 and 33% with 0. The discrepancy of ratings on general activities between physician and patient and better ECOG PS were predictors of negative PMI. BPI-R is a useful measure to assess cancer pain severity and its impact on patients? lives. Pain is inadequately managed in 66% of patients. Discrepancy of ratings on general activities between physician and patient and better ECOG PS are predictors of negative PMI. Implementation of BPI-R in routine palliative care is a first step toward improving the quality of pain management in Russia.