Thousands of people have expressed concern about pain management in A&E units in a poll of patients.
The Healthcare Commission survey of nearly 50,000 people found less than two thirds felt staff did everything they could to manage pain.
But overall nine in 10 patients said they were happy with the standard of service in hospitals in England.
A&E doctors admitted there were some areas that needed improving, but the government said it was pleased.
In total, 88% of patients rated their care as good, very good or excellent, with the numbers giving hospitals the top score rising slightly since the last survey in 2004.
'Worrying'
But the watchdog said the overall performance could not hide some worrying trends for individual aspects of the care package.
Just 59% of patients said they felt staff did everything they could to manage pain.
One in four people who requested pain relief said they had to wait more than 15 minutes, and 9% said they never got the relief they requested.
Concerns were also raised about the information patients were given.
Only 37% said they were given a complete explanation of possible side-effects of medicine they were given.
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Katherine Murphy |
Another third reported they were not told about the danger signs associated with their illness or injury that they should look out for after being discharged.
The poll also showed slight drops compared to the last survey in the ratings for privacy and respect and the way patients felt they were involved in their care.
And it revealed regional variations in the quality of services with London performing worse on many aspects of care.
The performance of hospitals in the capital has been an issue in previous reports from the watchdog and officials said they were looking into the trend.
Healthcare Commission chief executive Anna Walker said while the overall rating was good, hospitals still had lessons to learn.
"Patients have raised important issues."
And Katherine Murphy, of the Patients Association, claimed patients deserved better, adding: "Pain management is a critical part of care."
The watchdog also highlighted a concern about the four-hour waiting time target.
More than a quarter of patients said they were in A&E for longer than four hours.
Accusation
The Healthcare Commission suggested this could be because patients were being sent to assessment units, a kind of half-way house between A&E and the rest of the hospitals.
Managers have been accused of using these units as a way of getting round the target when they have not been able to treat or admit the individual within four hours.
Time spent in the assessment unit does not count towards the target.
The watchdog refused to get drawn into whether this was a deliberate tactic to hit the target or part of the proper assessment process.
But both the Lib Dems and Tories said hospitals were being pressured into manipulating waiting times.
Martin Shalley, of the College of Emergency Medicine, agreed it was probably happening "in some places".
And on pain he said: "More needs to be done.
"I think it is probably to do with time pressures. Staff do not always have the time to keep asking patients about pain during their visit to A&E. It is something we are trying to improve."
But he added: "Overall, however, we should be pleased with the performance."
Health minister Ben Bradshaw also said he was pleased with the results.
"There has been a dramatic improvement in recent years."
