BACKGROUND: Chronic musculoskeletal pain conditions affect millions of people worldwide and place a significant burden on individuals and the healthcare systems. Managing chronic musculoskeletal pain requires a multidisciplinary approach that considers biological, psychological, and social factors. However, access to multidisciplinary pain care is challenging, and long wait times can lead to increased stress and health deterioration. Mindfulness-based stress reduction (MBSR) is a mind-body approach developed specifically to reduce the distress of living with chronic conditions, such as chronic musculoskeletal pain. This study proposed a novel approach by offering an online MBSR program to patients on waitlists to attend a multidisciplinary pain clinic in Australia's public healthcare system that could improve health outcomes. The study aims to assess the feasibility, acceptability, and potential efficacy of this approach using a pilot study design with a mixed-methods approach. METHODS: This is a mixed-methods pilot randomised controlled trial with an embedded qualitative study. Participants will be recruited from waitlists at two multidisciplinary pain management centres within the Sydney Local Health District in New South Wales, Australia. This pilot trial will randomly assign 32 individuals with chronic musculoskeletal pain to either an online MBSR group or a usual care control group. Feasibility outcomes, patient-reported outcomes, adherence to mindfulness practice, and adverse events will be assessed using validated questionnaires. Semi-structured interviews will be conducted with participants in the MBSR group to explore their experiences and evaluate acceptability, and barriers and facilitators of engagement with the intervention. DISCUSSION: This pilot study will evaluate a novel approach to integrating MBSR into the Australian public healthcare system as a mechanism for providing support to individuals with chronic musculoskeletal pain who are waitlisted for a multidisciplinary pain management program. Findings from this study will indicate the feasibility, acceptability, safety, and preliminary efficacy of this approach in terms of patient-reported outcomes to guide the design of future large-scale clinical trials. TRIAL REGISTRATION: This trial was prospectively registered in the Australian New Zealand Clinical Trials Registry (ACTRN12622000822785).