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This study explored cognitive pre-sleep arousal in chronic pain patients with varying degrees of insomnia symptoms. Forty-eight adult outpatients with chronic pain completed the Pre-Sleep Arousal Scale (PSAS) and self-report questionnaires on sleep, pain, and other health and mood issues. Participants were divided into two subgroups based on scores on the Insomnia Severity Index and compared on PSAS scores. Results demonstrated that pain patients with moderate to severe sleep complaints (n = 32) reported higher levels of cognitive and somatic pre-sleep arousal than pain patients with mild sleep complaints (n = 16). Further comparisons with individual items on the cognitive PSAS revealed no differences between the groups on seven of the eight items. Worry about sleep was the only item to differentiate the pain patients with moderate to severe sleep complaints from those with mild sleep complaints. These results provide further support for extending a cognitive-behavioral model of insomnia to comorbid insomnia and chronic pain.