Background: Undertreatment of pain is common in emergency department. The major reasonsrnare lack of staff training in recognition, measurement and adequate pain treatment. Despite thernglobal attention being given over the years, undertreatment of pain in the clinical practice isrnstill an issue. rnObjective: The general objective of this study is to assess the pain treatment practice and itsrnimpact on patient satisfaction in the emergency department of Tikur Anbessa SpecializedrnHospital, July 15-19, 2019 Addis Ababa Ethiopia. rnMethodology: Single cantered, prospective, observational study for a continuous 24 hours ofrn5 days was conducted on total of 106 patients with history of recent pain. Numeric Rating Scalernwas used to assess patientâ€™s severity of pain. Each patient was evaluated twice, initially at triagernand 2-4 hours after arrival. The desire for analgesics was assessed at triage and Patientâ€™s levelrnof satisfaction was also assessed during the second evaluation. Data was analysed with SPSSrnversion 21 rnResults:rnOut of 106 patients male account for 57.5% with M:F ratio of 1.3. The mean age of participants rnwas 42.53years, with SD =16.3 years. The majority of patients were having medial emergencyrnfollowed by oncologic emergency and trauma. The mean initial numeric rating scale was 5.88rn(SD=2.09) measured out of 10. The proportion of patients who did not receive analgesics priorrnto emergency department were 77.4% (n=82), despite the fact that 57.5% (n=61) of them werernreferred by primary care taker. Desire for analgesics was found to be significantly associatedrnwith initial numeric rating scale. Despite the fact that 80.2% (n=85) of the patients desiredrnanalgesia, it was prescribed only for 51%(n=54) patients and actually taken by onlyrn41.5%(n=44). Asking for analgesics and patient presentation during day time werernsignificantly associated (p