Age distribution in developed countries is currently shifting towards older age. However, knowledge regarding diseases and treatment of the oldest patients remains incomplete, especially when it comes to acute and chronic pain. Pain assessment is complicated in these patients as they often have more than one diagnosis contributing to the clinical picture, in addition age-related changes in pain perception and cognitive impairment render evaluation of subjective symptoms difficult. Multidisciplinary pain management programmes that combine pharmacologic and non-pharmacologic treatment have proven efficacious in elderly patients. The choice of analgesics demands an understanding of age-related changes in drug-metabolism, co-morbidity and concurrent medication. Adjustment of drug doses and evaluation of benefits and risks should be tailored to each individual. There is an urgent need for better professional education programmes and further dedicated research specifically targeted to the needs of the elderly in our community.