In this national representative sample of longterm care NH residents in the United States, pain in residents who could communicate was positively associated with verbal aggression only and pain among residents who could not communicate was positively associated with both verbal and physical aggression. These results suggest that pain has differential effects on aggressive behaviors-depending on whether residents have the ability to self-report pain. One explanation is that residents who can verbalize pain are more likely to receive pain management, which reduces the risk of physical aggression. However, patients who cannot verbalize pain are less likely to receive adequate pain treatment, which increases the risk of physical aggression.