In recent decades, progress has been made in understanding pain mechanisms, both peripherally and centrally, The gate control theory, with its emphasis on psychological influences on pain perception, has revolutionized the way pain is viewed and managed. Yet, understanding certain aspects of pain mechanisms remains elusive. Although experimental studies of the effects of aging on pain thresholds are inconclusive, there is a trend toward lower pain tolerance and greater sensitivity to pain in the elderly. Given the widespread misconceptions and attitudinal problems related to pain in the elderly, the barriers to accurate assessments and effective management of pain need to be overcome. Unnecessary suffering for the elderly needs to be minimized, to promote their quality of life and enable them to maintain their functional abilities longer.