We evaluated the 1-year prevalence of pain syndromes and quality of care among 157 consecutive multiple sclerosis (MS) inpatients (90 f, 67 m) aged 19-85 years, with extended disability status scores of 1.0-8.5 and clinically definite MS. In a standardized questionnaire, only severe pain (pain intensity on visual analog scale of at least 4/10) was documented and classified which had occurred more often than three times or lasted longer than 1 week within the last year. Of 157 patients, 61% reported 176 pain syndromes: most frequent were headaches (40%), dysesthetic limb pain (19%), back pain (17%), and painful spasms (11%). Twelve percent of the pain syndromes were classified as worst symptom of MS, and in 68% insufficient care by the physicians consulted was reported. This was even true for the most frequent pain, migraine, in which clear treatment recommendations exist. There is thus an urgent need for physicians to keep this problem in mind when treating MS patients.