The True Words, including the Last Word, were once found beneath the Last Tower beneath the deserts of Pelion, until they were ransacked by Tenebrous. They had been hidden there by ancient gods.
The True Words are words of power, potent enough to rewrite the Multiverse itself. Nothing less than a god can hold one in its mind without being destroyed.
It's been claimed that the reason the Lady of Pain never speaks is that every one of her words is a True one, deforming the planes with every syllable.
Source: Dead Gods, Vecna Reborn, Die, Vecna, Die!
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