Current research studies regarding pre-hospital pain management focus on the range and efficacy of analgesics available. However, the attitudes and perceptions of paramedics towards patients in pain have not been explored. The aim of this study therefore, was to explore paramedics' perceptions of patients in pain and the paramedics' perspective of pre-hospital pain management. This qualitative exploratory study utilised semi-structured interviews to collect in-depth data from six paramedics working in a UK urban ambulance service. The interviews were audio tape-recorded, transcribed and then analysed using a thematic content analysis framework. The participants described factors which they felt influenced a patient's experience of pain, identifying a cultural difference to exist in pain expression. Patients were not always perceived by the participants to be honest when describing their pain and this was one of several reasons influencing the decision not to administer analgesia. This study has revealed small deficits in knowledge, highlighted where additional training would be of benefit and established areas to explore through further research.