Introduction/Objective: Pain is a common problem, which has a significant functional and quality of life impact on nursing home residents. The prevalence of substantial pain is thought to be as high as 80% among nursing home residents. Several causes of pain have been identified the most common being arthritis, others include cancer, low back pain, crystal induced arthropathies, and leg cramps. Multiple studies found that pain is both under recognized and under treated in nursing homes. The multiple medical problems as well as cognitive impairment and communication difficulties represent some of the difficulties in assessing and treating pain in these individuals. Pain in elderly long-term care residents has many well-documented consequences. Some of these consequences include depression, anxiety, decreased socialization, sleep disturbance, impaired ambulation, and increased health care utilization. Other conditions that may be worsened by pain are gait disturbances, slow rehabilitation, and adverse effects from multiple drug prescriptions. The most widely used management strategy is administration of analgesic medications. Non-opioid analgesics carry a high incidence of adverse effects in the elderly the most prominent being gastrointestinal bleeding from long-term use of NSAIDs. Opioids have been widely studied for persistent pain with proved efficacy. Older people constitute a heterogeneous population, making optimum dosage and common side effects difficult to predict. Some of the common adverse effects include constipation, nausea and vomiting, sedation, impaired judgment, impaired psychomotor function, and respiratory depression. Lower starting doses, longer dose intervals, and slow titration are used to limit these effects. A careful review of indication, comorbid conditions, degree of benefit and potential side effects is needed at the time of opioid prescription. Once a prescription is in place, a regular review of appropriate dosing, drug substitution and discontinuation is needed. A clear documentation of indication and review are often lacking in clinical practice. If this is truly the case then a policy of careful titration to effect and initially frequent review would seem sensible. The objective of this study is to establish the prevalence of opioid use and the associated documentation of indications and in a long-term facility.