Pain has been called the fifth vital sign, and chronic pain impacts the lives of millions. The search for better analgesics is at a fever pitch, but opiates still dominate the moderate to severe pain treatment spectrum, and morphine, essentially a 2000-year-old drug, is still the gold standard. By today's pharmaceutical standards, opiates are old hat, and physicians are generally reluctant to prescribe them due to their potential for adverse effects and abuse. It is suggested that a new look at another old solution, cobra venom, could inject new life into pain management. This review looks at the historical use of cobra venom to control moderate to severe pain and at recent understandings of its mechanism of action.