OBJECTIVES: There are multiple potential sources of pain in liver transplant (txp) pts with consequences of delayed healing, higher health care costs and decreased quality of life.  The objective of this study was to assess the incidence, quality, management and treatment satisfaction of pain after liver txp. METHODS: This was a cross-sectional analysis of ambulatory liver txp pts.  A questionnaire was developed using a modified Brief Pain Inventory.   Pts described location, intensity, and pain quality.  Pain symptoms were categorized as neuropathic, nociceptive and mixed pain.    RESULTS:  Sixty-eight pts were surveyed.  Eleven pts were within 3 months of txp (Group 1) and 57 pts were > 3 mos post txp, mean of 60 ± 59 mos (Group 2).  There were 38 males, 30 females; 10 AA, 58 Cauc;  mean age 56 ± 9 yr. Forty-three pts (63%) reported having pain today:  90% of Group 1 and 58% of Group 2.  Sixty-two percent of their pain was reported as new since txp.  Forty-six percent of pain was nociceptive, 12% neuropathic and 42% mixed.  Pain was most often in the lower extremities and lower back.  Current pain was reported as being 4.5 (median) on a scale of 1-10.  Pain interfered with sleep and normal work.  Thirty-four pts were taking pain medications.  Of these, more than 50% were taking 2 or more medication classes.   Only 5 pts were being followed by a pain specialist, but 80% of these were completely satisfied with their pain management compared to 55% when followed by primary care and 40% when followed by the transplant team.    CONCLUSIONS:  Half of pts post liver txp have pain that impacts their lives and most often requires long term medication use for pain relief.  Pts followed by pain specialists are more satisfied with their management than those followed by other health care providers.