This article aims to show how a discourse and communication based approach in the context of the care of the elderly provides a basis for reflecting on pain. Based on six hours of data from talk encounters between care professionals and elderly clients, an activity analysis of institutional settings and categorization of interactional discourse was undertaken. The focus  was:  (a)  how  elderly  people  initiated  painful accounts, and (b) how the professionals oriented to such  accounts.  It  is  found  that  pain-talks  are  governed by the institutional practice of different phases: framing; mapping troubles and symptoms; clients’ self  presentations;  counseling,  and  concluding.  This phase structure exemplifies knowledge of communicative  activities  and  is  part  of  practical  knowledge which  the  party,  or  at  least  the  professional,  is  expected to become acquainted with. A thematic interactional map of critical moments related to pain as (a) social death and hope, and (b) presentation of self as  past  and  self  as  present  emerges.  The  caring  aspect is to support hope and to change the focus from social death to life and recovering. In foregrounding health, it is important for the elderly people to affirm their identity of themselves as being good and honest persons.