Acute pain after medical procedures is often undertreated, opioid analgesics are used far too sparingly, and patients are forced to suffer needlessly as a result. Attempts to change health care practitioner behavior in the area of pain control are often futile. The purpose of the current study was to provide empirical evidence that supports the deleterious impact of acute pain. A prospective, longitudinal study was designed to assess the impact of pain during burn hospitalization on postdischarge follow-up of 122 patients. A composite score of patient ratings of procedural pain during hospitalization was composed. Regression analyses were used to compare the extent to which pain predicted long-term adjustment relative to potential competing variables such as the length of hospitalization, preinjury adjustment, and coping style. Pain during hospitalization was significantly associated with psychological adjustment at 1-month (53% return), 1-year (46% return) and 2-year (33% return) follow-up. Regression analyses indicate that pain was a stronger predictor than the size of the burn or length of hospitalization, and that this correlation could not be attributed to the patients' preinjury mental health history or coping style (for the 1-month and 1-year follow-up periods). Pain during hospitalization had a significant and enduring relationship with adjustment after burn injuries. Although causality cannot be definitively determined, the study findings provided compelling evidence for the value of controlling acute pain during hospitalization.