Pain is one of the chief complaints that leads to the diagnosis of venous disease and it can have a significant impact on patients’ quality of life. For the primary care physician or internist pain in venous disease is difficult to assess. This is due to pains multifaceted nature and due to the lack of association between pain as a symptom and the severity of venous disease. Many physicians view venous disease or varicose veins as a cosmetic issue. This is not the case, however the education of vein disease for a number of years was not present in medicine. Making assessment more difficult is that there is a variability of pain in venous disease. It remains difficult to explain, both clinically and symptomology. For some patients venous disease is so gradual that they just come to grips with the way their body feels. Often these patient will tell you after treatment that their leg feels so much better. These are often the patients with CEAP4 disease.