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INTRODUCTION: To evaluate the domains of pain assessment used in randomised controlled trials (RCTs) on pain management in acute pancreatitis (AP). METHODS: A systematic review of RCTs on AP pain management was conducted. Studies were analysed for domains assessed, methods of pain assessment, need for rescue analgesia and adverse effects of pain management. RESULTS: Sixteen RCTs, undertaken between 1984 and 2024, involving 1016 patients were included. Most trials (n = 15) employed a unidimensional pain assessment tool (Visual Analogue Scale in 12 and Numeric Rating Scale in 3). The multidimensional, modified-brief pain inventory (m-BPI) used in one RCT was the only tool that evaluated more than just pain intensity as a domain. There was notable variation in other measures of pain, efficacy of analgesia, the approach to rescue analgesia. The reporting of adverse effects was also highly variable, and most commonly included nausea, vomiting, and altered bowel habit. There were no data on quality of life or physical and psychological functions. CONCLUSION: The assessment of pain in RCTs relies almost entirely on unidimensional pain assessment tools, which do not capture the complexity of the pain experience. There is a need for multidimensional pain assessment tools specific to AP, which would allow better assessment of pain in clinical practice and in future trials.