Objectives: To evaluate the effect of interaction with a robotic seal (PARO) on pain and behavioral and psychological symptoms of people with dementia and chronic pain. Design: A parallel pilot randomized controlled trial conducted between January 2018 and January 2019. Setting: Three long-term care facilities in Australia. Participants: Forty-three participants aged ≥65 years living with dementia and chronic pain. Intervention: Participants were randomized to the PARO group (individual, nonfacilitated, 30-minute sessions, 5 days per week for 6 weeks) or a usual care group using a computer-generated random number. Measurements: The primary outcome was researcher-rated observational pain behaviors before and after each session. Secondary outcomes were staff-rated pain level, agitation, depression, and anxiety measured at baseline and the end of week 6. Medications regularly prescribed and as needed were recorded weekly. Analyses followed intention-to-treat, using the generalized estimating equation model. Australian New Zealand Clinical Trials Registry (ACTRN12618000082202). Results: Participants in the PARO group had a significantly lowered level of observed pain [−0.514, 95% confidence interval (CI) −0.774 to −0.254, P < .001] and used fewer pro re nata medications (−1.175, 95% CI −2.205 to −0.145, P = .025) than those in usual care after controlling for age, sex, cognitive function and medications. There were no significant differences in staff-rated pain, agitation, anxiety, and depression, nor regularly scheduled medications between intervention and control group. Conclusions and Implications: PARO shows promise in reducing pain and medications for individuals with dementia and chronic pain in long-term care facilities. This intervention might be incorporated into daily practice as an alternative to manage pain in people with dementia. Larger randomized controlled trials with longer time frames are needed to identify further and test the use of PARO in long-term care settings.