Background: There is evidence that knowledge about the prevalence of pain and quality of pain management particularly in nursing home residents (NHR) with severe cognitive impairment (CI) is poor.Methods: The multicenter cross-sectional surveys explored the prevalence of pain of NHR with or without CI from nursing homes in Germany. Actual pain intensity in rest and stress were documented. NHR were asked about their daily restrictions due to pain. Data about the pain management were collected and analyzed.Results: A total of 3437 residents were interviewed with respect to feeling pain, including one third each with mild and severe CI. The prevalence of actual pain was 31,8%. Women reported pain more often. Prevalence of NHR without CI or with self-report on pain was significantly higher than NHR with severe CI or with external report on pain. About 20% of all NHR were dependent on external pain-recording. Nearly 10% of all NHR with pain confirmed pain in stress above 5 on a scale of 0 - 10. 85% of all NHR with pain reported that they had pain for longer than 3 months. Residents with severe CI are 0.55 times less likely to take painkillers than NHR without CI.Conclusion: The study points out a significant deficit in pain management in German NHR with severe CI. Intensive training in pain management for employees in nursing homes is recommended.