Management of pain in the elderly is very challenging. First, the compromised ability to perceive pain because of loss of sensory neurons and other comorbid conditions such as dementia and degenerative joint diseases make the assessment of severity source and localization of pain very difficult. Second, decrease in the renal and hepatic blood flow and decrease in the hepatic and renal mass, along with decrease in volume of distribution caused by decrease in total body water and hypoproteinemia, makes the elderly very sensitive to adverse effects of different pain medicines. Third, many elderly patients have comorbid conditions causing impaired hepatic and renal impairment. In this article, we review the role of 2 more commonly used opiates, morphine and hydromorphone, in elderly patients with hepatic and renal impairment.