Pain is frequently one of the most disturbing symptoms of multiple sclerosis. It is caused by the disease process or its consequences, and may be one of the first symptorms of this condition. Trigeminal neuralgia, which is a very painful and often long-lasting problem, may occur at an early stage of the disease. Orbital pain is often caused by optic neuritis. Pain in the extremities, mostly painful cramps in the lower limbs, is almost intractable. It generally affects the most disabled people and is frequently therapy-resistant. The therapy of different pain syndromes is described.