The main concern was to show how a discourse and communication based approach in the context of the care of elderly, provides a basis for reflecting on pain. Based on six hours of recorded, transcribed and translated data from talk encounters between care professionals /elderly clients, an activity analysis of institutional settings and categorization of interactional discourse was made. There was a twofold focus: how elderly people initiate painful accounts, and how the professionals orient to such accounts. The pain-talks are governed by the institutional practice of phases: framing mapping troubles and symptoms, clients self presentations, counseling, and concluding. This structure shows the dialogical accounts as a communicative activity (type) of pain talk. A thematic interactional map of critical moments related to pain as 1) social death and hope, 2) and presentation of self as past and self as present, was achieved. The elderly talk about pain as an identity construction. Pain is a link between past, present and future identity. It is suggested that the caring aspect of professional skills is to support hope and to change the focus from social death to life and recovering.