Objective: To evaluate the prevalence of substantial daily pain among nursing home residents aged 65 and older. Design, Setting, and Methods: The Minimum Data Set (MDS) annual or admission assessment, available September 2002, for Alabama nursing home residents was used. Logistic regression was used to examine the association of such pain with nursing home characteristics as well as resident-specific factors. Results: The analysis is based on 27,628 nursing home residents 65 and older with mean age of 82.8 years; 20% African American; 25% male. Seventeen percent had substantial daily pain. By nursing home, reported substantial daily pain prevalence ranged from 0% to 54.7%. The prevalence of pain was less in smaller nursing homes (P < .001). Bivariate correlations were significant for all sociodemographic and mental status variables; number of medications; dementia; thyroid, musculoskeletal, neurological, pulmonary, and sensory disorders; allergies; anemia; and cancer. Factors independently correlated with substantial daily pain included (odds ratio, 95% confidence interval) sociodemographic characteristics: white race (1.5, 1.3-1.7), female (1.3, 1.2-1.5), married (1.1, 1.0-1.2), admission within year (2.0, 1.8-2.1); nursing home characteristics: nonprofit or government financing (1.3, 1.2-1.5), greater number of residents (1.4, 1.3-1.5); subject-specific conditions: no cognitive impairment (1.6, 1.5-1.7), communication ability (1.4, 1.2-1.5), sad mood/depression (1.5, 1.4-1.6), taking 10 or more medications (2.0, 1.9-2.2), musculoskeletal disease (1.9, 1.7-2.0), anemia (1.1, 1.0-1.2), and cancer (1.6, 1.4-1.8). Lower odds of substantial daily pain were associated with older age, rural locale, dementia, and thyroid, neurological, pulmonary, and sensory disorders. Discussion: This study highlights within-state variation in MDS reporting by nursing home as well as resident-specific factors associated with daily substantial pain. Rural, for-profit, and low-occupancy nursing homes had less documented pain. Communication ability and not having cognitive impairment were important factors in having such pain reported. © 2007 American Medical Directors Association.