Background People with intellectual disabilities (ID) are at risk that their health problems, many of which cause pain, go unrecognised and untreated. Their understanding and personal experiences of pain have received little research attention. Method Information was collected from 15 adults with ID using semi‐structured interviews about their experiences and understanding of pain. Transcripts were analysed using content analysis. Results Participants described pain using negative meanings and strong imagery, with various causes of pain suggested, but said little about how they coped with pain. Participants varied in whether they reported pains to carers, some choosing to hide the experience. There seemed a general belief that others can tell when someone is in pain. Conclusions Conversations regarding pain with adults with ID are a real challenge; health‐care staff need to think carefully about the questions they ask. Possessing verbal skills cannot be taken as an indication that pain will be communicated.