Pain is a common symptom in patients with chronic kidney disease (CKD) and end stage kidney disease (ESKD). It is often multidimensional with somatic and psychological components. Management of chronic pain in CKD is often inadequate and is associated with reduced quality of life, noncompliance with dialysis schedules, and emotional stress to patients and caregivers. Nephrologists often overlook management of pain with both under-prescription and over-prescription of analgesics being common. In this clinical practice case, we discuss the different dimensions of pain management in patients with CKD and ESKD. We emphasize that pain management is complex and requires multidisciplinary approach involving various specialties.