Intestinal obstruction (IO) frequently presents with abdominal pain as an early symptom. The duration of pain may reflect disease severity and can guide clinical decision-making.To evaluate whether the duration of abdominal pain is a significant predictor for the need for surgical intervention in patients with intestinal obstruction.A prospective observational study was conducted on 385 patients diagnosed with IO at Shyam Shah Medical College and Associated Sanjay Gandhi Memorial Hospital, Rewa (M.P.), between September 2022 and March 2024. Duration of pain prior to presentation was recorded and correlated with type of management—conservative or surgical.Patients with pain duration >48 hours were significantly more likely to undergo surgical management (p = 0.04). The likelihood of laparotomy increased proportionately with prolonged pain duration. Duration of pain is a valuable clinical indicator, Pain persisting beyond 48 hours is significantly associated with the need for surgical intervention and should prompt early imaging and surgical consultation.