Background and aims The influence of pain as well as Quality of Life (QoL) varies in accordance with biological, social, psychological and existential factors. This study investigates the influence of such factors on the relationship between pain and QoL among older adults from a gender perspective. Methods The Swedish National Study on Aging and Care (SNAC-Blekinge) baseline sample comprised 1402 individuals aged 60–96 years, of whom 769 (55%) reported pain. The participants were invited by a letter to take part in the study, which was carried out by research staff in two sessions of three hour each. Participants gave informed consent and completed a questionnaire between the two sessions. The reason for non-participation was registered among subjects who declined the invitation. Pain and insomnia were self-reported. Data on age, gender and if living alone or not were collected from the questionnaire. Co-morbidity was obtained from electronic patients records for a period of up to two years prior to participating in the SNAC study. SoC was measured by a translated short form from the original twenty-nine question instrument. QoL, was estimated using the HRQL Medical Outcome Study-Short Form (SF 12). In a model, pain, age, sex, insomnia, co-morbidity, living alone, sense of coherence (SOC), household economy, education and QoL were calculated through multivariate logistic regression. Results Among women, pain was found to have the highest OR (odds ratio) for low QoL [OR 2.27 (CI 1.36–3.78)], followed by low economic status [OR 1.75 (CI 1.08–2.84)], co-morbidity [OR 1.24 (CI 1.05–1.46)], low SOC [OR 1.08 (CI 1.06–1.10)] and lower age [OR 1.05 (CI 1.02–1.08)]. In men, insomnia was found to be the main contributor to low QoL [OR 1.86 (CI 1.04–3.33)], followed by low SOC [OR 1.08 (CI 1.05–1.11)] and lower age [OR 1.04 (CI 1.01–1.07)]. Conclusions Pain has a strong relationship with low QoL among elderly women. Insomnia is associated with low QoL among men who suffer less from pain. Thus the main result is a striking gender difference: Elderly women suffer from pain, elderly men suffer from insomnia. Implications It is important to take account of sex, age, sleep problems, co-morbidity, SOC and economic status in order to understand the relationship between pain and QoL among older adults.