Background: Acute pain is a leading cause of presentation to emergency departments (EDs) worldwide, yet robust data from sub Saharan Africa remain limited. Understanding its epidemiology is essential to optimise triage, analgesic strategies, and patient outcomes. Objective: To characterise the epidemiological profile of acute pain and identify independent determinants of severe pain among patients presenting to the ED of Essos Hospital Center. Methods: We conducted a prospective observational study over three months. Consecutive adult patients (≥18 years) presenting with acute pain were enrolled. Pain intensity was assessed at triage using a 10 point visual analogue scale (VAS). Etiologies were categorised as trauma-related, abdominal, obstetric/gynecological, or other medical. Multivariable logistic regression identified independent predictors of severe pain (VAS ≥7). Results: Among 220 patients (mean age 36 ± 12 years; 54% female; sex ratio 0.85), trauma-related pain accounted for 38% of presentations, abdominal 31%, obstetric/gynecological 18%, and other medical 13%. Severe pain was reported in 64% of patients. Independent predictors of severe pain were female sex (OR 1.7; 95% CI 1.1–2.7), trauma-related etiology (OR 2.3; 95% CI 1.4–3.8), and delayed presentation >2 hours (OR 1.9; 95% CI 1.2–3.1). Conclusion: Trauma, abdominal, and obstetric/gynecological conditions are the predominant causes of acute pain. Early, structured, context-adapted analgesia protocols are essential to reduce oligoanalgesia and improve emergency care quality in resource-limited settings.