The present research examined the effect of spousal autonomy support on the need satisfaction and well-being of individuals with chronic pain. Married individuals with a diagnosed musculoskeletal chronic pain condition (N = 109) completed a baseline questionnaire and a follow-up questionnaire after a 6-month time period. Cross-lagged analyses indicated that spousal autonomy support predicted increases in basic need satisfaction, and need satisfaction predicted increases in well-being. Moreover, the analyses in the opposite direction were not significant. Similarly, cross-lagged analyses were more supportive of the direction from pain intensity to lower well-being, rather than well-being to pain intensity. Finally, we tested a longitudinal structural model using pain intensity and spousal autonomy support as the predictors, basic needs as the mediator, and well-being as the outcome. The model provided a good fit to the data. Results showed that spousal autonomy support had a positive effect on the need satisfaction and well-being of individuals with chronic pain, independent of pain intensity. These findings extend self-determination theory to the chronic pain context and lay the groundwork for future chronic pain studies using the self-determination theory framework.