Background: Pain is the most impactful symptom of hidradenitis suppurativa (HS) and is highly correlated with patients' quality of life.Methods: This narrative review incorporates literature about HS pain, management of other chronic painful conditions, and expert opinion.Findings: HS causes complex pain with nociceptive, neuropathic, and nociplastic components. This article draws from knowledge about other painful conditions to propose a holistic approach to helping patients with HS manage their pain including characterizing the pain type, tips for effective physician-patient communication, and suggestions for pharmacologic and non-pharmacologic therapies. Conclusion:Pain is one of the most impactful and debilitating symptoms of HS.Improved understanding of the mechanisms that drive pain in HS as well as diseasespecific data supporting effective strategies for managing HS pain are greatly needed.