This issue of Clinics in Perinatology will carry the reader through the perinatal period and examine pain management throughout that continuum. Beginning with the genetics of obstetrical pain and opioid use in pregnancy, the discussion moves to the provision of anesthesia to the mother and fetus during fetal surgery - an area of intense concern and interest in many centers. There is an extensive discussion of both pharmacologic and non-pharmacologic management of pain during delivery. A discussion of regional anesthetic techniques is increasingly relevant in light of increasing evidence of adverse neurodevelopmental consequences of fetal exposure to general anesthetics and sedatives. Pain, its implications and management, are extensively covered including discussions of how to assess neonatal pain and how best to provide sedation and non-pharmacologic pain management, systemic pharmacologic, or regional techniques. Of particular interest are the reviews of the potential neurodevelopmental impact of both the treatment and the failure to adequately treat pain in the newborn. This topic is receiving an enormous amount of attention from all those who care for children as well as government and the media.