Theories of pain have been developed in several patient populations, but none currently exist for heart failure (HF) that include contributing factors and associated outcomes. We developed a situation-specific theory of pain in HF by adapting the biopsychosocial model of pain. Existing theoretical and empirical literature in HF samples was utilized to construct the new theory. Components, contributing factors, and associated outcomes of pain in HF are presented in the new theory. Areas in need of additional research are emphasized, and strengths and limitations are discussed. This theory could provide a foundation for future pain research initiatives in HF. Key words: pain, heart failure, theoretical model.