Background: Up to 70% of patients who present to the emergency department (ED) havernunderlying pain as a reason to seek help. Knowledge on pain management practice in the ED isrnlacking.rnObjective of the Study: The general objective of this study is to assess the practice of painrnmanagement in TASH adult ED. Specific objectives;rn1) Determine the socio-demographics of patients in painrn2) Determine the initial and subsequent severity of painrn3) Identify factors affecting analgesics(s) administrationrnMethodologies: A cross-sectional observational study was conducted on 123 patients withrnmoderate to severe pain presenting to TASH adult ED. A numerical pain rating scale was used torndetermine pain severity at two phases: initially at triage and after arrival into ED.rnResult: Out of 123 patients enrolled in the study were male (67.5%) with the median age ofrn32(min 14, max 90). Majority of patients were trauma accounting (59.3%) of all patients. Initialrnmean pain score was 7.7 and 79.7% of patients remained in moderate to severe pain despiterninitial physician evaluation and initiation of orders. Moreover for 39% of patients the pain eitherrndid not change (30.8%) or increased in intensity (8%) despite initial treatment. For 56.9% ofrnpatients analgesics were given, of which Tramadol was the commonest drug used (47.8%).rnAlthough 81.5% said they needed additional potent analgesics to be given, there was a record ofrnhigher satisfaction rate on overall pain management.rnConclusion: Initial high intensity of pain was documented and these are poorly recognized andrnmajorities were left inadequately treated.rnLimitation: The study was conducted in a single tertiary hospital ED, which makes it lessrnrepresentative of the common encounter in community hospital in the country.rnKey words: Emergency department, pain, pain management, TASH