Pain in older patients is often poorly treated. Some patients have a tendency to under-report their symptoms or are unable to communicate their pain. Clinicians do not always adequately investigate pain or are unaware of non-verbal cues of pain in cognitively impaired patients. We describe assessment and management of pain from a patient’s first interaction with the health-care team using psychological, non-pharmacological, and pharmacological strategies. WHO’s analgesic ladder is a good basis for treatment of pain and allows for use of adjuvants to complement standard analgesics. Drug side-effects are more common in elderly patients and often inhibit dose increases. A low-dose, slow-titration regimen is advocated, combined with appropriate support of patients for optimum management and to limit adverse events.