This article discusses three possible mechanisms that might underlie the often observed low use of nonsteroidal anti-inflammatory drugs (NSAIDs) and other analgesics in patients with Alzheimer's disease (AD), compared with nondemented elderly: (a) AD patients are progressively less able to communicate about pain; (b) AD patients suffer from fewer painful conditions than nondemented elderly subjects; and (c) considering the neuropathology, AD patients might actually experience pain to a lesser extent. Suggestions for future pain assessment in AD are made.