Mankind has searched throughout the ages for analgesic substances. Many natural products have been exploited. Investigating plants and plant-derived metabolites has advanced the understanding of important mechanisms related to the process of pain transmission, nociception and treatment. While modern, conventional Western analgesics represent the main pain medication prescribed in Japan, the traditional Kampo medicines composed of herbs are also used in daily analgesic treatment. The national health insurance system for Kampo medicines was established in Japan in 1976. At present, 148 remedies are covered by this health insurance system. More than 70% of medical doctors in Japan prescribe Kampo medicines to patients suffering from a wide variety of problems, including menopausal symptoms, chronic diseases, pain disorders and conditions with failed or suboptimal conventional therapy. In the anesthesia departments of many large medical facilities, doctors administer Kampo medicines, alone and in combination with conventional medications, to provide analgesia. Here, an overview is given to the history and the present state of Kampo medicine use in Japan for the management of pain.