The province, along with Xiangkhoang, was part of the Muang Phuan Kingdom (Vietnamese: Bồn Man) since the 14th century.

Following a Vietnamese invasion in 1478 led by King Lê Thánh Tông, it became Trấn Ninh Territory of the Đại Việt Kingdom with the capital at Sầm Châu (present-day Xam Neua).

In 1802, Emperor Gia Long of the newly founded Nguyễn dynasty ceded the region to the Kingdom of Vientiane.

However, in the aftermath of the Lao rebellion, Chao Nôy, the prince ruler of Muang Phuan, who earlier sided with the Siamese, was executed by the Vietnamese.

The principal rivers are the Sông Mã (which flows from and into Vietnam, passing the village of Ban Muang-Et) and the Nam Sam (which the town of Xam Neua lies on).

Key avifauna include great hornbill (Buceros bicornis) and Blyth's kingfisher (Alcedo hercules).

Key avifauna include beautiful nuthatch (Sitta formosa), rufous-necked hornbill (Aceros nipalensis), Blyth's kingfisher (Alcedo hercules), and yellow-vented warbler (Phylloscopus cantator).

[16] Socio-economic problems plague the province, with a higher infant mortality rate and lower access to safe water and medical facilities than the national average.

[16] In Viengxay District there are two bamboo processing factories that produce items such as floormats, fences, chopsticks and toothpicks for the Vietnamese market.

Principal cash crops include corn, sesame, soybean, and medicinal plants such as man on ling, duk duea, and kalamong, paper mulberry, styrax, cardamon and cinnamon.

[17][18] A tourism development plan has been created for the province, capitalizing on the caves as tourist attractions, providing information and services at the sites.

[19] Asian Development Bank launched a project in 2006 specifically covering 31 villages of Xam Neua and Samtay Districts to wean people away from shifting cultivation practices and to eliminate opium addiction; as of 2006, opium was grown in the province in an area of about 30 ha.

Apart from these finds, funerary burial sites with artifacts of ancient trinkets, standing rock slabs and stone disks were found.

These archaeological finds are older than the Plain of Jars and are seen along a 12-km mountain ridge in the southern part of the province.

[24][23] Local animists believe that the stone discs at the site once sat atop the megaliths and fed Jahn Han, the sky spirit.

[6] Tat Saloei (Phonesai) Waterfall lies off the road to Nam Noen, about 35 kilometres (22 mi) south of Sam Neua.

[6] Nameuang Hot Springs is another landmark amidst the valley of paddy fields on the way to Xam Neua, where there is the Houaiyad waterfall.