The assessment and management of acute pain is an essential part of care received in the emergency department (ED). This study was undertaken to measure how ED caregivers interpret and treat acute pain. A convenience cohort of 71 patients in a tertiary care teaching hospital were asked to rate their pain on arrival to the ED using a visual analog scale (VAS) and numerical rating scale (NRS). These ratings were compared with those given by their nurse and physician. Both physicians and nurses gave statistically significantly lower NRS and VAS pain ratings than those reported by the patients. Nurses' NRS pain ratings were found to be lower than physicians' ratings of the same patients. On chart review, no pain scale assessments were employed, and only one chart noted that a patient's pain had been relieved after treatment. Approximately half the patients (49%, n = 35) felt on discharge from the ED that their pain had not been relieved. Pain assessment and treatment in the ED appears to be inadequate. The integration of pain assessment before and after treatment is essential in monitoring the effectiveness of pain management in the ED.