AIM This paper is a description, comparison, and critique of two models and two theories used to guide symptom management research, and a proposal of directions for new theory or model development. BACKGROUND Symptom management research has undergone a paradigmatic shift to include symptom clusters, longitudinal studies that examine symptom trajectories, and the effects of interventions on patient outcomes. Models and theories are used to guide descriptive and intervention research. Over the past 15 years, four conceptual models or theories (i.e. Theory of Symptom Management, the Theory of Unpleasant Symptoms, the Symptoms Experience Model and the Symptoms Experience in Time Model) were used in a variety of symptom management studies. DATA SOURCES Literature searches were performed in Medline and the Cumulative Index of Nursing and Allied Health Literature between 1990 and 2008 for models and theories that guide symptom management research. Related papers and book chapters were used as supporting documentation. DISCUSSION Comparison and critique of the models and theories revealed important gaps including lack of consideration of symptom clusters, failure to incorporate temporal aspects of the symptom experience and failure to incorporate the impact of interventions on patient outcomes. CONCLUSION New models and theories should incorporate current trends in symptom management research, capture the dynamic nature of symptoms and incorporate concepts that will facilitate transdisciplinary research in symptom management. Researchers and clinicians need to build more expansive and dynamic symptom management models and theories that parallel advances in symptom research and practice.