RESULTS: The program has been run in 30 countries, delivered to 1,600 participants, and 340 instructors have been trained. Feedback has been positive, pre post testing in 27 sites showed a mean pre score of 65.89% rising to 75.23% (n = 581 respondents). A subanalysis demonstrates doctors and nurses improving by similar degrees. When local instructors have delivered the program after attending the trainer's session the participant test results were comparable to the results seen when the overseas instructors taught the course. DISCUSSION: The widespread adoption of the EPM program suggests there is a need for pain education in LMICs. The teach the teachers component of the program and the comparable results from their teaching should contribute to sustainability. Further support and mentoring using electronic systems such as Facebook, text messaging, and a website may also contribute to sustainability. BACKGROUND: Education for health care workers on pain-related topics is not always readily available, and this is especially so in low and middle income countries (LMICs). The Essential Pain Management program (EPM) has been developed to offer a simple interactive educational opportunity for health care workers in LMICs. METHODS: Following a needs analysis in Papua New Guinea, an 8 h educational program with the aims of improving pain knowledge and providing a simple pain management framework was developed. An evaluation of the program using the Kirkpatrick model is being used. The program has a "teach the teachers" component to encourage sustainability.