Background. Worldwide, pain is amongst the leading causes of disability in young people and the most common reason for individuals to seek health care. Persistent or recurrent pain for 3+ months is considered chronic pain, affecting 11-38% of young people. If poorly managed, chronic pain may persist into adulthood, causing distress and at its worst increased suicidal risk. Chronic pain may be a highly prevalent, easily identifiable, and manageable target for suicide prevention efforts. Yet, research on the relationship between chronic pain and suicidal risk in adolescence is sparse, leading to a lack of knowledge about why suicidal distress might occur in the context of chronic pain. Aims. We will explore how prevalent suicidal distress is in adolescents with chronic pain and which aspects of the pain experience are associated with suicidal distress and what might be protective. Methods. In this cross-sectional, mixed-methods study, 77 adolescents with chronic pain were recruited from the Oxford Centre for Children and Young People in Pain. Participants completed surveys on their pain experience and suicidal distress (perceived burdensomeness, hopelessness, and self-harm thoughts and acts), as one distress pathway leading to suicidal outcomes. In an optional interview, 59 participants described their pain experience and how it affects their feelings. We analysed the data, using reflective thematic analyses, descriptive statistics, and regression models. Results. Participants were aged 12-18 years (79% female, 90% White British/European). Most (78%) reported persistent pain with pain attacks, often in multiple locations. Preliminary results reveal high prevalence rates of perceived burdensomeness (65%), hopelessness (75%), and lifetime self-harm thoughts (58%) and behaviours (47%). In the qualitative interviews, participants shared rich details on their pain experience, identifying key domains where severe distress can emerge and what might be protective. Detailed results will be discussed once the analyses are finalised. Conclusions. Findings show alarming rates of suicidal distress in adolescents with chronic pain in a specialised pain management service. By identifying key domains where risk can emerge and the factors that might be protective, findings may have direct implications for the management of suicidal risk in clinical settings.