A prospective blinded observational study was carried out to document acute pain assessment and management in an academic emergency department. Over a 2-month period, 42 patients with a primary complaint of pain were studied. Physicians and nurses did not document levels of pain or changes in pain during patient stays. Eleven of 42 patients had severe pain upon arrival, 5 of whom received medications, only 1 obtaining good relief. No other patient received medication, although five others received some intervention for their pain. Eleven of 38 patients who were discharged home had severe pain on discharge. Despite minimal pain relief, patient satisfaction with pain management was relatively high. Pain assessment and treatment may be poorer than previous retrospective studies have indicated.