PURPOSE OF REVIEW: This review examines recent advances and findings in the field of pain management in patients undergoing thoracic surgery. RECENT FINDINGS: Acute and chronic postoperative pain continues to remain a major problem and a primary concern for patients. Although thoracic epidural analgesia is still considered a 'gold standard', more evidence exists that paravertebral blockade has similar efficacy with a better side-effect and safety profile. The cornerstone of pain management remains a multimodal therapeutic strategy that provides both a central and a peripheral block by combining regional techniques with opioid and nonopioid analgesics. SUMMARY: Pain after thoracic surgery has a profound impact on perioperative outcome. Beyond the immediate perioperative period, acute pain contributes to the development of the debilitating chronic pain syndrome. Going forward, both procedural and pharmacologic interventions for acute and chronic pain should be studied in definitive multicenter, well designed randomized clinical trials.