Multiple sclerosis is a chronic autoimmune disease of the central nervous system characterized by neuroinflammation, demyelination and axonal damage leading not only to motor and sensory deficits but also to chronic pain syndromes. Among them, vertebrogenic pain syndromes occupy a special place. They occur on the background of neurological deficit, muscle-tonic and myofascial dysfunctions, as well as postural and metabolic disorders. Impaired spinal biomechanics, myoadaptive overloads, and secondary degenerative changes contribute to pain persistence. Contribution of central sensitization, anxiety-depressive disorders, and neurotrophic insufficiency gives vertebrogenic pain syndromes in multiple sclerosis a particularly complex pathophysiological profile. Current evidence emphasizes the need for comprehensive multimodal approach to diagnosis and management combining rational pharmacotherapy, physiotherapy, kinesitherapy, psychotherapeutic methods and neuromodulation. Since pathophysiological mechanisms underlying chronic pain in multiple sclerosis remain complex and insufficiently understood, further studies are needed to elucidate their neurobiological basis and to develop new therapeutic strategies aimed at improving treatment efficacy and quality of life.