There were several limitations to this study. First, it should be noted that the percentage of aggressive behavioral symptoms in this study was low compared with that of other studies. For example,reported that 41% of patients with dementia developed aggression. Thus, our results may be because of either well managed patient care in NHs or an under reporting of aggressive behavioral symptoms. Second, this study was limited by secondary analysis of federally man dated MDS assessment data in NHs. The sensitivity analysis in the adjusted HLM modeling showed that the relationships among study variables remained the same, indicating robustness across NH settings. Because the study design was descriptive and cross-sectional, the study does not provide a temporal direction for the observed associations between pain and aggressive behavioral symptoms. Third, only resident-related variables in the MDS were included this study. The unmeasured individual or other factors that contribute to aggressive behavioral symptoms (e.g., staff mix and ratio complexity, and ambient environmental conditions were not included. Finally, there was no differentiation of types or length of time of dementia diagnoses in the MDS, so no subgroup analysis was possible on these variables.