Suboptimal management of pain in emergency departments (EDs) remains a problem, despite having been fi rst described over two decades ago. A `before-and-after? intervention study (with a historical control) was undertaken in one Western Australian tertiary hospital ED to test the effect of a `nurse-initiated pain protocol? (NIPP) intervention. A total of 889 adult patients were included: 144 in the control group and 745 in the intervention group. Patients in the intervention group were: More likely to have a pain score recorded than those in the control group; have reduced median time to the fi rst pain score; and reduced time to analgesia. The statistically signifi cant reduction in both time to pain score and time to analgesia remained, even when adjusted by age and sex. Whilst we demonstrated the safety and effi cacy of a NIPP in ED, an unacceptable proportion of patients continued to have inadequate pain relief.