Background Pain is common in emergency medical services, and abdominal pain is among the most frequent complaints. This study examined whether documented pain assessment, analgesic treatment, reassessment, and documented end-of-encounter pain status in patients with acute abdominal pain differed by clinician competence (Prehospital Emergency Nurse [PEN] vs. non-PEN), patient sex, age, and prehospital interval. Methods This retrospective observational study was a secondary analysis of adult patients with acute abdominal pain in a previously described cohort. Electronic patient records were reviewed in full, including Numerical Rating Scale (NRS) scores and free-text pain descriptions. Primary outcomes were documented pain assessment, analgesia administration, and any documented reassessment. Secondary outcomes were documented NRS use, analgesia among patients with moderate-severe pain, reassessment after analgesia, and mild pain at the last documented assessment. Age and prehospital interval were dichotomized at the median. Mann-Whitney U and Fisher's exact tests were used, with p < 0.01 considered statistically significant. Results Of 840 sampled records, 816 were included. Median age was 64 years (IQR 41-79), and median prehospital interval was 38 minutes (IQR 27-60). Compared with non-PEN encounters, PEN encounters had higher rates of pain assessment (67% vs. 53%, p = 0.003), analgesia administration (50% vs. 37%, p = 0.005), and reassessment (31% vs. 17%, p < 0.001). Among patients with moderate-severe pain, analgesia was more frequent in PEN encounters (81% vs. 58%, p < 0.001). Mild pain at the last documented assessment was also more common in PEN encounters (23% vs. 8%, p < 0.001). Younger patients and cases with longer prehospital intervals had higher rates of pain assessment, NRS use, analgesia administration, and reassessment, but not mild pain at last assessment. Conclusions The PEN encounters showed higher rates of documented pain assessment, analgesia administration, and reassessment, with a higher proportion of patients having mild pain at the last documented assessment. Differences related to age and prehospital interval were mainly limited to process measures. Further research is needed to clarify whether clinician competence and care processes translate into improved pain relief.