Orofacial pain is often the impetus for patients to seek dental care, and endodontic disease accounts for a significant proportion of this pain. That said, fear of pain during dental procedures is a major deterrent for many prospective dental patients. Thankfully, pain management strategies have significantly improved over time. The foundation of pain management is the determination of pain source and development of a definitive diagnosis. Delivery of definitive care, either by endodontic therapy or extraction, is the best way to provide complete relief of pain of endodontic origin. Beyond this, pain management should be considered prior to the provision of definitive care, perioperatively while care is being delivered, and postoperatively until signs and symptoms of inflammation and infection resolve.