As many as 45% to 80% of nursing home residents have pain that contributes materially to functional impairment and decreased quality of life. Substantial barriers, including a high frequency of dementia, multiple pain problems, and increased sensitivity to drug side effects often make pain assessment and management more difficult in the nursing home setting. Logistic problems in carrying out diagnostic procedures and management interventions are also common. Pain can be alleviated in nursing homes through the careful use of analgesic drugs combined with nonpharmacologic strategies, including exercise programs and other physical therapies. Elderly nursing home residents are more sensitive to the side effects associated with many analgesic drugs, but this does not justify the failure to treat pain, especially in those who are terminally ill or near the end of life. Structured programs for routine pain assessment and treatment are needed. Physician involvement in pain assessment and management is necessary if pain control is to be improved for nursing home patients.