Pain is an undertreated, understudied problem in the growing elder population. Clinicians need to consider the compelling evidence that a significant majority of this population experience pain that interferes with quality of life and normal functioning. The barriers to adequate pain management must be addressed and misconceptions corrected. It is critical to identify both acute and chronic pain. Pain assessment and reassessment need to be performed regularly and used in treatment selection. Consideration of physiologic changes that occur in the aged will guide choices of pharmacologic and non-pharmacologic therapies. Pain assessment and treatment must be recognized as fundamental care issues.