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People with intellectual disabilities are amongst the most disadvantaged in society in terms of satisfying their health care needs. Although significant advances have been made, there is still little research on the management of pain in people with learning difficulties. Cognitive impairment causes late presentation of illness, unreliable self-reporting of pain, difficulty in understanding pain and difficulties in decision-making and consent to treatment. Initial assessment and evaluation of therapy is difficult. Furthermore, those with cognitive impairment are at risk of more complex and severe illness and more likely to undergo painful surgical procedures. Quantitative somatosensory testing of pain threshold in individuals with mental retardation suggests than they are more sensitive to heat pain than normal people. Communication difficulties are a commonly cited reason for inadequate provision of health care, so it beholds the health care provider to improve communication methods. Communication through carers may mean that the accuracy of the history is lost. Assessment has been undertaken through physiological, behavioural and socioemotional responses depending on functional ability and level of disability.