Morphea, also known as localized scleroderma, is characterized by idiopathic fibrosis of the skin and adjacent structures. Patients with morphea classically present with skin lesions without any associated symptoms and the lesions usually regress spontaneously over time. We describe a patient with morphea who presented with debilitating pain in her skin plaque. She failed topical therapy and required systemic methotrexate to control her disease. We titrated the methotrexate dose with the goal of pain relief. Although unusual, pain associated with morphea can be debilitating. Physicians should assess for pain in patients with morphea and prescribe treatments accordingly. We propose using pain, when present, in addition to physical examination as a guide for titrating morphea therapy.