The adequate management of severe pain in accident and emergency departments depends on knowledge of the pharmacology of analgesic drugs. To evaluate such a knowledge a study by questionnaire was conducted. Fourteen accident and emergency departments participated and one hundred senior house officers answered the questionnaire. A large percentage of the respondents would use an inappropriate route of administration (intramuscular 50% rather than intravenous 50%), some would use an inappropriate drug and often wait too long (90 min) before giving a further dose of analgesic should the patient continue to be in severe pain after the initial dose. These results suggest that there is need for further teaching on pain relief at medical schools, casualty officers need to be taught about analgesia when they start working in accident and emergency departments, and it may be beneficial for accident and emergency departments to have an analgesic policy.