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Background: Pain is the most common reason for attending the emergency department (ED), being reported by 78% of patients. Pain relief is often not feasible because of a number of barriers related to the health care system, the health care providers and the patients themselves, giving rise to a prevailing situation of undertreatment of pain (oligoanalgesia) in the ED. Aim: To determine the factors that contribute to undertreatment of pain in the ED, and to identify barriers to pain management as perceived by emergency care nurses. Method: Α literature search was made with the help of the electronic databases of Medline, Medscape and Scopus for the years 2000 to 2010, using the key-words: “Pain management”, “pain management barriers”, “emergency department”, “nursing”, “oligoanalgesia”. Results: ED overcrowding, lack of primary health care and absence of a pain management policy in the ED appeared to be the most important organizational problems reported by nursing staff in regard to pain treatment. The nursing staff contributes to the inadequacy of pain management, with lack of documented assessment, underassessment of pain intensity and erroneous attitudes towards analgesia, due to insufficient education in this area. Patient refusal of analgesia and demand for narcotics also appear to be causes of oligoanalgesia. Conclusions: Pain assessment and treatment in the ED are not based on valid tools of estimation and treatment protocols. Pain management is low on the administrative scale of nursing staff and pain is evaluated only as a clue to potentially life-threatening pathology. The rights of patients to receive better pain relief are not ensured by nursing personnel, resulting in inadequate management of pain in the ED.