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38.5% of the Spanish working population reports pain, 5.1% severe pain. Pain is associated with a high utilization of health services, but, more importantly, with a significant reduction in the ability to continue their work performance. Interventions to minimize the significant costs inflicted by pain should be implemented. Objective: The objective of this paper is to provide an overview of the epidemiology of pain in the Spanish working population and to investigate the incremental costs of the different levels of pain on medical costs and productivity losses. Methods: This is a cross-sectional study of costs of pain in the Spanish working population from a societal perspective using data from a national representative survey. Results: Data from the 9919 respondents were analyzed. The prevalence of reported pain was 38.5%: 21.9% mild or very mild; 11.5% moderate; 5.1% severe or extreme. Increased self-reported pain was independently associated with significant increases in direct and indirect costs. Those reporting severe or extreme pain showed excess annual costs of €5118.97 per case, being 85% indirect costs. Conclusions: Spain is paying a heavy price for the high prevalence of pain in its working population. [ABSTRACT FROM AUTHOR]