Objective: Pain and itch symptoms are common after major thermal burn injury (MThBI) - requiring tissue autografting. To our knowledge, no prospective longitudinal studies have characterized pain and itch outcomes after tissue autografting and associations between and functional interference caused by such symptoms. Materials and Methods: We prospectively evaluated burn graft site and tissue donor site pain and itch severity (0 to 10, numeric rating scale) over 1 year among a representative cohort of MThBI survivors (n=96) who received tissue autografting within 14 days of MThBI. Results: Nearly all participants had moderate or severe burn pain at the time of enrollment. Most individuals experienced an upper extremity burn with donor tissue taken from thigh. Persistent moderate or severe burn graft site pain declined thereafter, but remained common, with 25/90 (28%), 24/77 (31%), and 17/82 (21%) experiencing moderate or severe pain at 6 weeks, 3 months, and 6 months, respectively. Although there was improved function after immediate postinjury decline in all participants, those who had moderate or severe pain showed worse functional outcomes at each timepoint. Significant correlations were present between itch and pain burden over time at the same site (ie, autograft site r=0.629, P<0.01) and also across sites (ie, autograft and donor site itch r=0.552, P<0.01). Discussion: Pain and itch are common after MThBI, are temporally and spatially concordant and cause significant impact on daily function. Further studies are needed to better understand pain and itch symptom pathogenesis after MThBI, to reduce the tremendous suffering and decline.