Objective: To analyze the risk factors of moderate to severe abdominal pain after first-time transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC), and to establish the predictive model. Materials and methods: Two hundred and nineteen patients with HCC who underwent first-time TACE in our hospital between January 2021 and June 2023 were collected. According to the time of TACE, the study population was divided into training (n=154) and validation (n=165) cohort in a ratio of 7:3. Patients in the training cohort were divided into abdominal pain (n=42) and no-abdominal pain (n=112) group, according to whether moderate to severe abdominal pain occurred or not after TACE. Demographic and clinical data were compared between two groups. Logistic regression (LR) analysis was used to identify the risk factor of moderate to severe abdominal pain after TACE, and to establish the predictive model. Receiver operator characteristic (ROC) curve analysis was used to evaluate the performance of the model for predicting moderate to severe abdominal painafter TACE in both training and validation cohort. Results: Among the 154 patients in the training cohort, moderate to severe abdominal pain occurred in 42 (27.3%) patients. LR analysis showed that, distance between tumor and hepatic capsule was less than one centimeter (P=0.001), the use of iodipin was more than 10 milliliters (P<0.001), and the use of dehydrated alcohol during embolization (P=0.007) were independent risk factors of moderate to severe abdominal pain. The predictive model was as follows: 2.199 × distance between tumor and hepatic capsule was less than one centimeter + 2.252 × the use of iodipin was more than 10 milliliters + 1.637 × the use of dehydrated alcohol during embolization - 3.829. The areas under the ROC curves of using the model to predicting the moderate to severe abdominal pain were 0.895 and 0.853, respectively. Conclusions: Distance between tumor and hepatic capsule was less than one centimeter, the use of iodipin was more than 10 milliliters, and the use of dehydrated alcohol during embolization were independent risk factors of moderate to severe abdominal pain. The predictive model can provide reference for the management of moderate to severe abdominal pain after first time TACE in patients with HCC.