OBJECTIVES: Multiple Sclerosis (MS) is an unpredictable, chronic neurological disease with a prevalence in Canada of 0.24%. Prevalence of associated pain ranges from 10% – 80% with an average of about 50%. Pain can be musculoskeletal or nerve related and affects patients' quality of life. We estimated the prevalence and the burden of pain due to MS in Canadian MS patients from the perspective of society. METHODS: The study protocol was approved by a central Institutional Research Board and by participating hospitals. 297 patients were recruited either through MS clinics or the MS Society. Resource utilization data over the previous six months were collected by telephone interviews with the patients for direct (drugs, physicians, hospitalizations) and indirect costs (time loss). Indirect costs were based on time loss using the Canadian average industrial wage. Costing was calculated with Ontario prices and fee schedules, applying 2004 Canadian dollars ($CAD). Mean cost per patient were determined (SD, range etc.). The burden was extrapolated to the Canadian population using national demographics and prevalence rates for MS and pain in MS. Spearman's Rho assessed the relationship between cost and pain severity. RESULTS: The average age was 49 (±11) years, with 77% females. The prevalence of pain due to MS in this study sample was 71% (211/297). The mean total direct cost per patient for pain in MS over a 6-month period was $2528 (SD=$5695), with hospitalization as the highest contributor (mean = $711). The mean total indirect cost for the same period was $669 (SD=$875). We observed a positive trend between cost and pain severity measured by the BS-11 scale (Rho=0.291, p=0.0001). The projected six-month burden for Canada was $65,034,679. CONCLUSIONS: Pain due to MS in Canada is associated with substantial costs to patients and society.