Background and Aims Pain is one of the commonest reasons a patient seeks assistance in the emergency department (ED). The goal of the study is to assess the key points of acute pain management in the emergency and the disaster setting.

Methods The inclusion criteria used were: a) articles referring to acute pain management in the ED, the disaster and the prehospital setting, b) research that focused on pain assessment methods during emergencies, c) guidelines on pain therapy protocols and methods of pain alleviation, d) studies analyzing reasons behind pain under-treatment in the ED. The exclusion criteria were: a) studies referring to chronic pain management, b) research on pain treatment outside the emergency setting.Three major themes were identified: a) acute pain perceptions, b) acute pain assessment and c) acute pain treatment.

Results On acute pain perceptions, literature search highlights problems related to healthcare systems and misconceptions among healthcare workers, rendering pain alleviation, during emergencies and disaster, disregarded. On pain assessment, numerous studies emphasize the need for standardized self-reporting pain measurement tools, when it comes to evaluate a patient’s pain intensity and severity. Various treatment modalities exist that can successfully guarantee pain alleviation in almost any setting. Lessons acquired from environmental and military disasters emphasize on the use of interventional techniques, like peripheral nerve blocks.

Conclusions The problem of pain management extends far beyond a single country or a single ED. Physicians should recognize pain as a true emergency and treat it as such.