Chronic pain represents a complex health problem that affects a significant number of individuals living in the community. Paramedics will encounter patients with a complaint of pain that may be associated with injury, malignancy, and degenerative diseases such as osteoarthritis. In some cases, the patient may have a diagnosis of ‘neuropathic pain’ where there is no obvious basis for the pain. Some individuals with chronic pain may experience exacerbation of pain. This may occur in association with malignancy and disease progression, and when the pain becomes unmanageable, this becomes a health emergency. These individuals may rely on paramedics to manage this distressing symptom. However, in order to care for patients with chronic pain, paramedics need to understand the physiology of pain, use validated tools to assess pain, and appreciate the range of therapeutic approaches used to manage this debilitating symptom. As such, this article aims to provide information to support the paramedic's assessment and management of patients with chronic pain. Paramedics have practice guidelines for the management of acute pain, and these may be adapted to care for patients with acute exacerbation of chronic pain.