This review aims to describe and evaluate current practices and controversies surrounding provision of pain relief in the prehospital setting. The review addresses analgesia indications and contraindications, frequency with which analgesics are used, and factors associated with improved prehospital analgesia care in Emergency Medical Services systems with both physician and non-physician staffing. As part of its evaluation of the state of the art in prehospital pharmacologic treatment of pain, the review will summarize available evidence relevant to the major drugs. Although some situations have been insufficiently studied to allow for definitive data-driven analgesia recommendations, the review will, where possible, include evidence-based recommendations concerning prehospital pain medication.