OBJECTIVES: Patients identified pain as one of the key symptoms they experience during early development of the Psoriasis Symptom Inventory (PSI), an 8-item measure of psoriasis symptom severity.  This analysis addresses the consistency and relevance of pain evaluated in a supplemental qualitative study in patients with psoriasis. METHODS: Individual concept elicitation (CE) interviews and cognitive interviews (CI) were conducted in adults with moderate to severe plaque psoriasis (Body Surface Area ≥10, PASI ≥ 12, Physician Global Assessment ≥3).  Subjects were recruited from four different US sites. Interviews were audio-recorded and transcribed.  Concepts were identified and coded using Atlas.ti software.  Additional questions during the interview asked patients to rate the severity of their symptoms on a scale of 0 to 10.  Relevance of pain to the patient experience with psoriasis was assessed using the patients’ descriptive language to identify related themes and assign codes to similar content.  Resulting concept codes were evaluated for predominance (how much patients talked about each concept), severity, and being offered spontaneously. RESULTS: The 30 subjects interviewed (CE, N=20; CI, N=10) were between 27 and 75 years of age (mean of 52), and were 30% female and 60% white.  Concept codes for pain comprised 11% of all the expressions patients offered about their symptoms.  Pain was the fourth most predominantly discussed symptom in the interview transcripts.  In 11 of the 20 CE interviews subjects spontaneously offered pain as a symptom and rated its severity as 6.2 out of 10. CONCLUSIONS: These qualitative findings regarding the presence and severity of pain provide evidence for the inclusion of pain as a key symptom concept of relevance to patients with moderate to severe psoriasis.