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The population of Western countries is ageing, which presents the clinician with special challenges. Specific painful conditions such as post-herpetic neuralgia and pain after stroke afflict the older population, whereas conditions such as osteoarthritis become increasingly important with advancing age. The older patient may be unable to communicate to health professionals because of deafness or cognitive decline, and prior experience of illness or privation (such as surviving a war) may lead to an attitude of stoicism, with unreported pain. The concept that older patients suffer less pain with advancing age is unfounded, unhelpful and results in undertreatment of pain.