Neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein-associated disease (MOGAD) are autoimmune disorders frequently accompanied by chronic, often neuropathic, pain, which significantly impacts the quality of life, sleep, and mental health. This study evaluated the incidence and characteristics of neuropathic pain in 106 patients with NMOSD or MOGAD and assessed its effects on mental health, sleep quality, and overall quality of life. Using clinical evaluation and MRI findings to localize lesions, pain classification revealed that chronic pain was more common in NMOSD patients (78.4%) than in MOGAD patients (52.7%), with a significant impact on both groups. Patients with MOGAD who experienced neuropathic pain reported notably poorer sleep quality and higher anxiety and depression levels. Pain severity was strongly associated with spinal cord lesion length and thoracic location, particularly in MOGAD patients. Current treatments provide insufficient pain relief, highlighting the need for more effective management strategies. This study emphasized that neuropathic pain substantially diminishes both physical and mental well-being in NMOSD and MOGAD patients, highlighting the importance of personalized pain management approaches to improve quality of life and mental health in these populations.