Introduction: Many patients come to emergency department because of acute pain, resulting from trauma and are conducted by analgesics. This study investigated the effect of adding nefopam to ketorolac using pain score and the used pethdine. Materials and Methods: Trauma patients who received nefopam at the emergency department of ----- Hospital for 1 years from January 2012 to December 2012 were enrolled. The patients who are younger than 15 years are excluded. Medical records was investigated retrospectively. Pain score was estimated by numerical rating scale (NRS) before medication and after 30 min of medication. Primary outcome is to determine change of score. And secondary outcome is pethidine treatment or not. Results: Total 1465 trauma patients received pain control treatment. There was not a significant difference of pain score change between the 5 groups by initial analgesics, nefopam, ketorolac, pethdine, adding nefopam to ketorolac and adding nefopam to pethidine. Pethidine was necessary for 22 patients from 112 in nefopam group, 141 from 867 in ketorolac group and 29 from 121 in adding nefopam to ketorolac group with no statistically significant difference. Conclusion: For trauma patient in emergency departmnet additional nefopam is not more effect. However, effect of nefopam only is compare favorably with ketorolac only and petidine only group in changing of pain score.