Adequate pain management in trauma patients in (prehospital) emergency care can be very problematic. Less than a generation ago the prevalent attitude towards acute pain management was a widespread acceptance that pain was inevitable and frequently professionals were often indifferent to a suboptimal approach. Nowadays adequate pain management is understood to be a fundamental human right and integral to the ethical patient-centred practice of modern medicine. Furthermore long-lasting acute pain can have a deleterious effect on the patients' physical and emotional recovery and can ultimately lead to chronic complaints. This thesis addresses the problems of early and initial pain management in trauma patients in (prehospital) emergency care. Injury and accidents at home leading to acute pain can be the personal experience of many of us. Although ambulance personnel (further referred to as paramedics) and emergency nurses are often the first contacts for trauma patients in pain all members of the trauma team are responsible for adequate pain management. Therefore early and initial pain management in this thesis concerns ambulance personnel emergency nurses and physicians and (orthopaedic) trauma surgeons in emergency care. The topics in this thesis are reflected upon from a nursing perspective which can be considered to be unique in a multidisciplinary team approach. Nurses contrary to doctors are focused on maintaining health and the care of patients rather than on the cure of injuries or diseases. It therefore offers an additional input towards pain management during a decision making process of professionals for a person in pain.