Pain is an extremely common problem among the elderly in all settings. However, it is often under- reported and commonly under- assessed. Individual beliefs and attitudes have long been considered important factors in how people respond to pain. So, this study aimed to explore the beliefs and attitudes of the institutionalized elderly regarding pain and its / management. The study included 85 elderly recruited from three geriatric institutions in Alexandria. Two approaches were used in the study; a qualitative one utilizing focus group discussion methodology, and a quantitative one comprising structured interview. The results showed that the majority of the elderly were females [71.8%], young old [60% ] and illiterate or just read and write [70.58]. Most of the elderly [88.2%] had chronic pain experiences. Most of them believe that pain is a common and expected problem for the elderly due to the presence of several health problems and that they have to put up with their pain. The majority believes that they can tolerate pain more than the young. Most of them were reluctant to express their pain due to different reasons. Inconsistency regarding the appropriateness, effectiveness and complications of pain relieving medications was found among the elderly, but the majority believes that these drugs are not good for them. Many elderly adopted distraction and other measures to relieve their pain.