AIM The aim of this study was to explore whether a patient's lifestyle influences nurses' pain assessment and management decisions. BACKGROUND Nurses' inferences of physical pain are thought to be affected by a matrix of implicit assumptions that operate without effort and thought, motivating behaviour and guiding reactions in the clinical setting. Studies have demonstrated how patient characteristics not only influence assessment but also the nurse's choice of pain management. DESIGN One of two patient scenarios was employed in a self-administered questionnaire that also addressed pain knowledge, inferences of physical pain, general attitudes and beliefs about pain management. The variable lifestyle/socio-economic status (SES) of the patient was manipulated; all other patient variables were kept constant. The participants were then required to identify the patient's pain level and make pain management decisions. METHOD One hundred questionnaires were distributed and 86 were returned. Following selection of the sample, 72 nurses participated in the study: 35 hospice/oncology nurses (specialist) and 37 district nurses (general). Data analysis was carried out using SPSS and qualitative analysis of the written responses. RESULTS Both the specialist and general nurses differentiated between the patients in the scenarios, influencing their decisions to acknowledge the patient's self-report and choice of pain management. However, both patients were undermedicated with the nurses identifying undue concern about addiction and respiratory depression. CONCLUSION The findings lend direct support to the proposal that a patient's lifestyle/SES can affect nurses' pain management behaviours. RELEVANCE TO CLINICAL PRACTICE It is proposed that schemas induce bias that then influence nurses' inferences of patients' physical pain and management decisions; this is compounded by the myths about addiction and respiratory depression. It would appear that educational and clinical experiences fail to ameliorate the affects of bias and myth.