Depends on the story- if it's a legitimately-painful episode, I'll work as hard as I can to palliate it.
I was counseled and thought of openly, negatively, by administration and coworkers at EMSA as "the candyman", because I had a reputation for medicating patients who were in pain. It worked out to be about 8% overall of the people I'd see in any given month on average. I was one of the only medics that would medicate abdominal pain at the time in Western Division. Plenty of them didn't even know it could be done.
There's multiple levels to your question. Let me break them down:
1. Medical: Is there a medical reason to medicate this pain? As TXMed said, many injuries can actually be palliated quite effectively with the rarely-practiced art of good positioning, cooling and even psychological measures like distraction. The pediatric femur fracture we took the other day needed no medication because he literally forgot about it when we tucked him into his carseat and let Mommy ride with him in the back- babies in pain don't generally babble and laugh. Same goes for things like scrapes and minor burns- cryrotherapy is a great option. Ask what the problem is and remove thorns, small pieces of glass and gravel, etc. One of the dumbest EMTs I've ever met insisted that protocols forbade us from removing glass from a superficial hand laceration and reported me to the admin for pulling a shard out of a finger...but it was the right thing to do.
Then there's considerations of pharm: route, authorized and anticipated-necessary dosages, allergies and sensitivities, comorbidities, etc. The medical goo that we deal with. One of the biggest considerations is if our meds will even be effective in the dosages we are allowed. For example. a medic working in a system that requires him to give 0.25mcg/kg of fentanyl q10 for "acute pain" with a cap of 100mcg and who has a 100kg patient with an open tib/fib does legitimately have a claim that their therapy is not anticipated to be effective at all. There are then considerations of hospital follow-on, etc.
2. Operational: Does this make sense to take care of in the truck?
3. Cultural: This is the big variable. Plenty of places and medics have conservative opinions of pain management or outright don't view it as a normal part of their job, use it as a weapon against "********" patients, or simply don't care enough to use it. Others have hyperconservative practices (think the people who BLS in hip fractures because they don't want to risk missing an IV). Others are lazy and make their partners tech most calls. Others don't see a need for it in patients with "minor" causes of pain, like isolated fractures. Fear is a big one- fear of adverse effect, fear of opinion and fear of administration (a side effect of nailing the most aggressive medics to the wall as examples of what not to do). Most of these traits are actually cultivated in larger organizations (the "high-performance systems" in order to keep narcotics use and restock down and limit the chances of a paramedic overdoing something. From the managerial perspective, it's better that a thousand patients get temporarily undertreated than it is for one person to suffer an injury attributable to the agency's actions, and that leads to active official and unofficial cultivation and enforcements of very arbitrary standards. For example, when I was at EMSA, it was a point of pride between most of the medics I worked with that they didn't open their narc boxes on a 12-hour. People like me who did were openly derided. Few people like being derided by their coworkers, especially when those coworkers are seemingly respected by one another and the organization more than you.
Culture is easily the hardest nut to crack. A lot of the above people are actually really capable providers, adequate at the routine and good, even stellar, in the clutch. It's really hard to get rid of that attitude, though, so you might find that a paramedic who is a rock star with intubation and STEMI detection and skills and even has good people skills may not believe in pain management and rarely, if ever uses it. It's a huge challenge that has a massive impact on patient care but is mostly unknown, and I doubt it stops in the ambulance either.
