An enigma in the management of pain is its etiology, it was generated to the extent that became available op- erational techniques and diagnostic imaging, factors to which was added the lack of comprehensive patient man- agement, which overlapped the diagnosis, pain relief, thereby generating erroneous behavior and postponing a fundamental right of the patient, to be free from pain, it probably was generated since 1921 when Sir Zachary Cope, in his book “Early Diagnosis of Acute Abdomen”, proscribed the use of analgesia –primarily morphine– in patients with abdominal pain, because achieving this purpose, signs and symptoms of an abdominal catastrophe in progress were obscured. Until now, this approach in the management of acute pain is a barrier to achieve qual- ity standards in the management of patients with pain, especially acute pain.