Results: chronic pain, multisite pain, and mental distress were associated with total sa. chronic multisite pain was associated with long-term sa (rate ratio [rr] 2.51, 95% ci 1.17-5.42), and chronic pain (rr 5.04, 95% ci 2.14-11.87) and multisite pain (rr 4.88, 95% ci 2.30-10.33) with long-term sa among those with mental distress. for women, there was a synergistic interaction of multisite pain to the association with total sa (synergy index 1.80, 95% ci 1.27-2.54). conclusions: chronic and multisite pain associate with sa among young and midlife employees. the associations are generally stronger among women and particularly among those with concurrent mental distress. interventional studies are needed to confirm if early symptom recognition and support could reduce sickness absence. key messages: chronic pain and pain at multiple body sites associate with sickness absence among young and midlife employees, particularly among women and those with concurrent mental distress. interventional studies are needed to confirm if sickness absence could be reduced by early recognizing pain and mental distress among employees and providing preventive and therapeutic services