To assess the incidence and relationship of cognitive/intellectual impairments to pain problems, seventy-three adults with musculoskeletal pain seen in a PM&R outpatient clinic were screened using the Neurobehavioral Cognitive Status Examination (NCSE). Subjective pain complaints were assessed using portions of the McGill Pain Questionnaire. Patients with prior diagnoses of neurocognitive problems or those who had taken narcotic analgesics in the last 24 hours were excluded. Results showed that 32 percent of subjects had impaired performance in at least one cognitive domain. Individuals with poorer performance on the NCSE had higher levels of reported pain or disability and psychological distress. Possible factors contributing to poor performance on cognitive tasks include psychological disorders or distress, undiagnosed organic brain dysfunction, social/psychological factors such as education, or a combination of these. Results suggest the need for further research to understand the relationship of poor performance on cognitive tasks to the etiology, maintenance and rehabilitation of pain problems.