OBJECTIVES: This study determined factors associated with treatment choice for pain management in US nursing home hospice/palliative care residents. METHODS: This is a cross sectional study of data from the resident file of the 2004 National Nursing Home Survey (NNHS). Residents assigned to a bed in a hospice specialty unit or receiving services from a special program for hospice/palliative care in 1174 systematically selected nursing homes and having pain in 7 days before the survey were included. Treatment choices included standing order (SO) of analgesics, as-needed orders (PRN) of analgesics and non-pharmacological treatment (NPT). Factors evaluated were gender, marital status, age, ethnicity, eating limitation, toilet limitation, urinary incontinence and bowel incontinence. Weighted descriptive analysis, bivariate analysis using chi-square tests and multivariate analysis using logistic regression were conducted using SAS version 9.2 to determine factors associated with pain management. RESULTS: Overall 22.6% (338,029/1,492,207,weighted) patients met the study inclusion criteria. Mean[SD] age was  79.1[13.3] years , 74.7% were females and 89.8% were white. 78.6%, 49.8%, and 29.3% received PRN, SO, and NPT, respectively. Logistic regression showed higher likeliness to receive SO for patients of age at or above 65 years (OR=1.51 95% CI=1.184-1.948 P=0.001), patients with bowel incontinence (OR=1.21 95% CI=1.020-1.437 P=0.028) and Medicaid patients (OR=1.5 95% CI=1.258-1.799 P<0.0001). Likeliness to receive PRN was lower for patients of age at or above 65 years (OR=0.60 95% CI=0.428-0.841 P=0.0031), patients with bowel incontinence (OR=0.67 95% CI=0.533-0.859 P=0.0014), Medicaid patients (OR=0.65 95% CI=0.525-0.806 P<0.0001) and Hispanics (OR=0.327 95% CI=0.204-0.527 P<0.001). Likeliness to receive NPT was higher for patients with toileting limitation (OR=2.905 95% CI=1.135-7.434 P=0.026) and lower for patients with urinary incontinence(OR=0.022 95% CI=0.003-0.172 P=0.0003). CONCLUSIONS: Factors affecting treatment choice were age, bowel and urinary incontinence , toileting limitations,  ethnicity and insurance type and can be targeted in future studies aiming at management of pain in nursing homes.