Seeking care for prolonged musculoskeletal pain is very common in primary care. We aimed to analyse the pain-related drug use patterns among primary care patients with musculoskeletal pain. The study population consisted of 358 adults visiting a primary care physician due to nonacute musculoskeletal pain. Pain-related medication use, sociodemographic data and pain-related factors were recorded. Depression and mental distress were assessed using the 13-item Beck's Depression Inventory and the 12-item General Health Questionnaire. A chi2 test and logistic regression analysis were used to study the associations between drug use and background factors. The physicians diagnosed musculoskeletal pain in 572 patients. Patients' response rate was 63%. Of these patients, 63% had used prescription drugs and 46% over-the-counter (OTC) drugs during the week preceding the visit. Three out of ten patients (28%) had used drugs daily and 29% had used more than one drug simultaneously due to pain. One out of six patients had used sedatives or hypnotics. The use of prescription drug was closely related to the severity of pain and to the previous visits due to present pain. OTC drug use was associated with living alone. Depression or mental distress associated closely with daily use, multiple drug use and especially hypnotic or sedative use. Among primary care patients with musculoskeletal pain, daily drug use and multiple drug use as well as the use of sedatives or hypnotics are common. These drug use patterns are associated as closely with sociodemographic factors or mental distress or depression as with pain severity.