This study examines psychosocial factors affecting health care utilization (HCU) in patients residing in rural AL who participated in psychosocial treatment for chronic pain. Based on previous literature, it was hypothesized that depression, disability, education, and quality of life would predict health care utilization both pre- and post-treatment. Additional exploratory aims included investigating whether completion status predicted health care utilization post-treatment and if the self-reported psychosocial measures predicted completion status. HCU data were gathered from medical records at two AL rural health centers and included number of visits, interval between visits, prescription analgesics, and comorbidities. Participants also completed the Pain Catastrophizing Scale, Roland Morris Disability Scale, Quality of Life Scale and Center for Epidemiologic Studies Depression Scale before as well as after treatment. Medical records for 64 participants were available for review. The participants were predominantly African-American (67.2%) females (73.4%) with an average age of 49.34 years and mean duration of pain of 18.5 years. Multiple regression analyses revealed that depression and pain catastrophizing predicted number of visits pre-treatment with depression accounting for most of the variance while catastrophizing and quality of life contributed to the model predicting the average interval between visits pre-treatment. Perceived disability and catastrophizing contributed to the regression model for HCU post-treatment. In regard to treatment completion, the latter was uniquely and significantly predicted by education, depression, quality of life, and catastrophizing. Thus, although rural patients in this study shared several common predictors of HCU with urban patients, catastrophizing emerged as an important predictor of both health care services use and treatment completion in this study, seldom reported in previous studies.