In the intensive care setting, patients often have pain that is unrelieved or inadequately managed. Pain management is particularly challenging in patients who are unable to self-report their pain levels. Poorly managed pain is associated with a number of adverse outcomes. This descriptive study compared pain management practices between neurosurgical and trauma patients in a Trauma/Neurosurgical Intensive Care Unit (TNICU) at an urban teaching hospital. It was hypothesized that traumatically injured patients would receive more opioid analgesia than the neurosurgical patients in the same unit. Medical chart audits (n=27) were completed to measure the amount of opioid each patient received. The amount of morphine equivalent units for trauma patients (n=13) and neurosurgical patients (n=14) was then compared. As hypothesized, the trauma patients received more opioid analgesia than the neurosurgical patients. The mean amounts of morphine equivalent units per day were found to be 21.1 for the trauma patients and 13.8 for the neurosurgical patients. While this result was not statistically significant, it suggests current trends in pain management practice in this TNICU. Although the trauma patients were found to receive more analgesia, most of these patients received less than 10 morphine units per day even though they had multiple injuries. Patients often receive less analgesia when they are cognitively impaired and/or unable to communicate. Neurosurgical patients may have sub-optimal pain management due to the fear that opioid analgesia will impair neurological assessment. This descriptive study highlights the need for pain assessment tools for the non-verbal critically ill patient, as well as the need for increased pain management.