Objective：To analyze the risk factors for moderate to severe abdominal pain in patients with hepatocellular carcinoma （HCC）after their first transarterial chemoembolization（TACE）and to establish a predictive model. Methods：A total of 219 HCC patients who underwent first-time TACE in our hospital between January 2021 and June 2023 were collected. Based on the chronological order of receiving TACE treatment，the patients were divided into a training set（154 cases）and a validation set（65 cases）in a 7∶3 ratio. The training set patients were further categorized into the moderate to severe abdominal pain group and the non-moderate to severe abdominal pain group based on whether moderate to severe abdominal pain occurred after TACE，and demographic and clinical characteristics were compared between the two groups. Logistic regression analysis was used to analyze the risk factors for moderate to severe abdominal pain after the first TACE treatment in HCC patients and to construct a predictive model. The receiver operator characteristic（ROC）curve method was used to evaluate the predictive performance of the model in the training and validation sets for the occurrence of moderate to severe abdominal pain after TACE. Results：In the training set of 154 cases，42 cases（27.3%）of HCC patients experienced moderate to severe abdominal pain after TACE. Logistic regression revealed that tumor distance from the liver capsule ≤1 cm（P=0.001），iodized oil usage >10 mL（P < 0.001），and the use of non-alcoholic ethanol embolization（P=0.007）were independent risk factors for moderate to severe abdominal pain after the first TACE treatment in HCC patients. The predictive model was 2.199×tumor distance from the liver capsule + 2.252×iodized oil usage + 1.637×use of nonalcoholic ethanol-3.829. The ROC curve areas for predicting moderate to severe abdominal pain in the training and validation sets were 0.895 and 0.853， respectively. Conclusion：Tumor distance from the liver capsule ≤1 cm，iodized oil usage >10 mL，and the use of nonalcoholic ethanol embolization are risk factors for moderate to severe abdominal pain in HCC patients after their first TACE treatment. The predictive model can provide guidance for the management of moderate to severe abdominal pain in HCC patients after their first TACE.