Pain is one of the most common problems for patients who present to the Emergency Department (ED), thus a timely and effective pain management intervention is essential for quality patient care. A comprehensive literature review was undertaken in an effort to document the prevalence of pain and to increase knowledge about patients' preferences regarding pain management in emergency situations. Results indicated that the prevalence of pain is high and pain management, including treatment, is often unsatisfactory in the ED. Common procedures, such as offering pain medication after medical consultation or when diagnostic intervention is completed, were shown not be effective in meeting patient needs. Patients prefer that their pain is treated upon admission to the ED; their need for effective treatment increases with pain intensity. Reasons that patients may refuse pain medication include fear of addiction and side effects. While most patients do not expect being to be pain-free upon discharge, most do expect more effective pain relief than they are currently receiving. Relationships between sociodemographic factors and patient preferences could not clearly be elicited from the literature. A weakness is that the reviewed studies were descriptive and published primarily in the United States in the last five years. There is a need for further research in this area, particularly studies that investigate patients' preferences regarding pain management in European EDs.