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OBJECTIVE To determine the rate of establishing care and factors related to chronic pain patients' establishing care with pain psychology after pain physician referral. DESIGN Retrospective study. SETTING Academic Tertiary Care Center. SUBJECTS Patients from the UCSD Center for Pain Medicine. METHODS This is an IRB approved, retrospective study of 150 consecutive referrals of unique patients from UCSD Pain Medicine to UCSD Pain Psychology. RESULTS 74/150 (49.3%) of patients referred to pain psychology established care with pain psychology.58/98 of patients who had previously seen mental health services established care with pain psychology (59.2%, 95% CI 49-69%) versus 16/52 (30.8%, 95% confidence interval 18-43%) who had not (OR 3.26, 95% CI 1.60-6.66).Among the patient subset with depression and/or anxiety, 47/82 (57.3%, 95% CI 47-68%) of patients who had previously seen mental health services established care with pain psychology versus 3/20 (15%, 95% CI -1-31%) of those who had not (OR 7.61, 95% CI 2.07-28.01).43/96 (45%, 95% CI 35-55%) referred for general pain psychology evaluations established care versus 24/38 (63%, 95% CI 48-78%) referred for implantable device pre-procedure evaluation. CONCLUSION Patients are significantly more likely to establish care with pain psychology if they have previously seen a mental health professional. This was even more marked among the patient subset with a history of depression and/or anxiety who had engaged in mental health services than those with a history of depression and/or anxiety who had not engaged in mental health services. Whether referral was for general psychological evaluation or implantable device pre-procedure evaluation did not significantly influence whether patients established care. Targeted interventions are needed to improve likelihood of patients engaging with pain psychology services.