BACKGROUND: Chronic pain and mood disorders are common in older people. Their relationship however remains unclear. Only a few studies have investigated the role of pain in mental health service use and received psychopharmacological treatment. METHODS: Cross-sectional study of the 65+ subsample from the European Study on the Epidemiology of Mental Disorders (ESEMeD). 4401 non-institutionalized individuals were interviewed using the third version of the Composite International Diagnostic Interview (CIDI-3.0). RESULTS: Painful physical symptoms (PPS) were more likely in people with a 12-month major depressive episode (MDE) than in those without (OR=2.0). Help seeking for emotional problems was uncommon, but PPS were a significant predictor of help-seeking (OR=1.7). Respondents with MDE more frequently used benzodiazepines than antidepressants. The presence of PPS in respondents without depression resulted in a significant increase in the use of psychotropic medication. CONCLUSIONS: PPS were strongly and independently associated with major depressive disorder. Their presence had an influence on help seeking behavior and use of psychotropic medication. LIMITATIONS: The cross-sectional nature of this study does not allow determination of direction of causality.