Although there is information available about pain in elderly persons, there have been very few studies about pain among the oldest old. In Sweden, 8% of the population is older than 74 years, and 2% is older than 84 years. It is the group over 74 which is growing fastest in proportion to the entire population. The aims of the present study are (a) to analyze if pain increases or decreases with age in the oldest age groups and (b) to study gender differences regarding pain. The present study of a random sample (n = 537) of the oldest old in Sweden shows that there is some evidence of decreased musculoskeletal pain with age. Among women, total reported pain decreases with age. Among men, there is an increase of reported severe pain with age. Including the results from another Swedish population survey of individuals aged 18-84, there is evidence that the prevalence of pain among the older elderly is comparable to the prevalence of pain among the middle-aged (45-64) and is higher than the prevalence among the younger elderly (65-75). Musculoskeletal pain is more common among old women than old men but for chest pain and abdominal pain there is no difference. The sex difference is more pronounced for multiple and severe pain complaints. The prevalence of mild or severe pain in any of the studied locations in the whole study group (77+) was 73% and for individuals over 85 years, 68%. For multiple pain, the figures were 47% for all older elderly (77+) and 46% for individuals over 85 years of age. For severe pain in at least one location, corresponding figures were 33% and 35%.