Background: Pain management in the Emergency Department is challenging. Do we need to ask patients specifically about their pain scores, or does our observational scoring suffice? The objective of this study was to determine the inter-rater differences in pain scores between patients and emergency healthcare (EHC) providers. Pain scores upon discharge or prior to ward admission were also determined. Methods: A prospective study was conducted in which patients independently rated their pain scores at primary triage; EHC providers (triagers and doctors) separately rated the patients’ pain scores, based on their observations. Results: The mean patient pain score on arrival was 6.8 ± 1.6, whereas those estimated by doctors and triagers were 5.6±1.8 and 4.3±1.9, respectively. There were significant differences among patients, triagers and doctors (P< 0.001). There were five conditions (soft tissue injury, headache, abdominal pain, fracture and abscess/cellulites) that were significantly different in pain scores between patients and EHC providers (P<0.005). The mean pain score of patients upon discharge or admission to the ward was 3.3 ± 1.9. Conclusions: There were significant differences in mean patient pain scores on arrival, compared to those of doctors and triagers. Thus, asking for pain scores is a very important step towards comprehensive pain management in emergency medicine.