Concerns about pain management in South Dakota generated survey research in 2001. Knowledge of and attitudes toward pain management were assessed through a survey of health care professionals, and standards of practice and education efforts in the area of pain management were evaluated by a questionnaire sent to South Dakota health care facilities. Results show gaps in knowledge, attitudes that hamper adequate treatment of acute and chronic pain, and the need for a seamless approach to standards of practice in pain management for health care facilities. Results and recommendations for interventions and future research are discussed.