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Catherine E Dube, Reynolds A Morrison, Deborah S Mack, Bill M Jesdale, Anthony P Nunes, Shao-Hsien Liu, Kate L Lapane Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USACorrespondence: Kate L LapaneDivision of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 398 Plantation Street, Worcester, MA 01655, USATel +1 508-856-8965Fax +1 508-856-8993Email kate.lapane@umassmed.eduPurpose: To provide contemporary estimates of pain by level of cognitive impairment among US nursing home residents without cancer.Methods: Newly admitted US nursing home residents without cancer assessed with the Minimum Data Set 3.0 at admission (2010– 2016) were eligible (n=8,613,080). The Cognitive Function Scale was used to categorize level of cognitive impairment. Self-report or staff-assessed pain was used based on a 5-day look-back period. Estimates of adjusted prevalence ratios (aPR) were derived from modified Poisson models.Results: Documented prevalence of pain decreased with increased levels of cognitive impairment in those who self-reported pain (68.9% no/mild, 32.9% severe) and those with staff-assessed pain (50.6% no/mild, 37.2% severe staff-assessed pain). Relative to residents with no/mild cognitive impairment, pharmacologic pain management was less prevalent in those with severe cognitive impairment (self-reported: 51.3% severe vs 76.9% in those with no/mild; staff assessed: 52.0% severe vs 67.7% no/mild).Conclusion: Pain was less frequently documented in those with severe cognitive impairment relative to those with no/mild impairments. Failure to identify pain may result in untreated or undertreated pain. Interventions to improve evaluation of pain in nursing home residents with cognitive impairment are needed.Keywords: pain, nursing homes, cognitive impairment, dementia