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Few studies have reported on prevalence of pain and pain management within psychiatric settings; this study aims to fill that gap. Secondary analysis of cross-sectional anonymized population-level data from the Ontario Mental Health Reporting System (N = 315,934 unique individuals) was conducted to identify associations between psychiatric diagnoses and recognition of pain management needs while controlling for factors previously linked to pain. Approximately 22% reported pain, yet only 49% had recognized pain management needs. Age under 65, financial trade-offs, heavy drinking, opiate use, self-reported trauma, PTSD, substance use disorder, and cognitive impairment were associated with increased odds of recognition of pain management needs, while admission from an institution or homelessness, repeated psychiatric admissions, substance use, health instability, and several psychiatric diagnoses were associated with decreased odds. 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