OBJECTIVE: To examine the characteristics, satisfaction levels and clinical outcomes of rural and remote Australians with chronic pain completing an internet-delivered psychological pain management program (PMP). DESIGN: Longitudinal routine care cohort study. SETTING: An Australian national digital psychology service. PARTICIPANTS: Patients in inner regional locations (n = 401), outer regional and remote locations (n = 198), and major cities (n = 968), who used the service over a 6-year period. MAIN OUTCOME MEASURES: Demographic and clinical data, patient-reported satisfaction and improvements, and meaningful clinical improvements (≥ 30% improvement). RESULTS: Clinical improvements were observed from pre-treatment to post-treatment in pain-related disability (32% [95% CI: 29, 34]), depression symptoms (44% [95% CI: 39, 49]), anxiety symptoms (43% [95% CI: 39, 47]), and average pain intensity (23% [95% CI: 21, 26]), which were maintained to 3-month follow-up. High levels of satisfaction and treatment completion were also observed. Minor demographic and clinical differences were observed. However, there were similar rates of clinical improvement, treatment satisfaction and treatment completion in all groups. CONCLUSIONS: The current findings further highlight the value of internet-delivered psychological PMPs for Australians with chronic pain living in regional and remote parts of the country. Further work is needed to raise awareness about the availability of these effective programmes and to integrate their use with traditional pain management services.