The American Pain Society's (APS) patient outcome questionnaire was used to examine patient satisfaction with pain management in a quality assurance study of 217 adults and 31 children in a large university hospital. On a scale of 1-6, mean (S.D.) patient satisfaction with pain management provided by nurses was 5.37 (1.02) and by physicians was 5.10 (1.02). Many patients (84% of adults and 90% of children) reported that early in their hospital stay a nurse or physician had communicated the fact that treatment of pain is considered very important. The mean (S.D.) pain severity score (worst pain in the last 24 h) for adults was 6.62 (2.79) on a 0-10 scale and for children was 4.33 (0.85) on a 0-5 Faces scale. Analyses revealed little relationship between pain severity and satisfaction; even persons with high levels of pain were very satisfied with the pain management they received from nurses and physicians. Satisfaction was, however, related to whether nurses and physicians had communicated to the patient that pain management has a high priority. It appears that patients are satisfied if clinicians say they want to provide pain management regardless of whether they actually do. The data raise questions about the interpretation of patient satisfaction as an outcome variable in studies of the quality of pain management.