Pain and falling both affect substantial segments of the older population. Despite the presence of several plausible mechanisms for pain to contribute to falling, very few studies have investigated this relationship in older people. If pain is a falls risk factor, this represents a potentially important point of intervention for falls prevention. Falls are a major cause of disability and loss of independent living status in older people. We examined the relationship between pain, pain-related interference with activities and falls in a cross-sectional analysis of 3509 people aged 49 years or more in two postal code areas in New South Wales, Australia (the Blue Mountains Eye Study). We found that subjects reporting pain with moderate to severe level of pain-related interference with activities were more likely to report any falls or multiple falls in the past 12 months than subjects not reporting pain (adjusted prevalence ratios 1.42, p=0.0001 and 1.62, p=0.0156, respectively). We also found a significant trend in the association indicating an increasing likelihood of self-reported falls associated with increasing level of pain-related interference with activities. The association was stronger for multiple falls than for any falls. Excluding subjects with recent fractures did not alter the findings. Given the high prevalence and public health importance of both conditions, further investigation of this association in prospective studies is recommended.