Severe acute pain can mean an emergency. Severe acute pain can be the result of many conditions that acutely occur. Some of it are a pulmonary embolism, angina, acute abdomens such as acute appendicitis, acute pancreatitis and many more. Acute pain is different in terms of time length compared to chronic pain which is longer and often persistent. It is essential to take a proper history of severe acute pain and get the physical examination done. Usually, for pain management, it is always referred to as the stepped approach of pain management. For mild to moderate pain, simple analgesics such as paracetamol or NSAIDs or weak opioids such as tramadol will be used. However, in severe acute conditions, strong opioids such as morphine will be used also some other adjuvants will be added for Nerve Pain. Treating the cause is always a good way of managing acute severe pain.