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Purpose of Review: Heart failure is a leading cause of significant disability and death throughout the world. The assessment and management of pain syndromes in heart failure require specialized knowledge of the pathophysiology of pain and of heart failure. Effective treatment entails an understanding of the physical, psychological, spiritual and social aspects of the pain experience and how pharmacological interventions need to be carefully tailored in this patient population. As we intensify technology to manage the challenges of heart failure it is critical that we review as a profession this critical issue., Recent Findings: We will review the various aspects of the pain experience for the heart failure patient, disease-specific treatment modalities and ways to incorporate existing expertise in pain management in to the care of these complex patients. Most recently the Pain Assessment, Incidence & Nature in Heart Failure trial has been completed and is currently in publication. This study was the first attempt at trying to understand the complexity of pain in the heart failure patients and will be the foundation for future work., Summary: In closing, as palliative care and hospice move further in to the care of patients with complex, chronic illnesses, it is essential that we take this foundational work and expand upon it. Recognizing that pain and suffering in the heart failure patient is multidimensional and that the physical experience of pain is multifactorial is the beginning of developing expertise and improving the quality of care delivered to these patients.