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Work-related factors are known to be associated with musculoskeletal pain (MSP), however psychological distress may also play an important role. The study aims to evaluated the association between psychological distress and work-related factors, and multisite MSP among teachers.This is a cross-sectional study conducted among teachers from six states in the Peninsular of Malaysia. Information on demographic characteristics, psychological distress, work-related factors and MSP from seven anatomical sites were collected using a self-administered questionnaire. Weight and height were measured using standardised methods. The association between MSP at three or more sites in the past month, and psychological distress and work-related factors were assessed using multivariate logistic regression.6796 teachers from 391 schools completed the questionnaire. The prevalence of self-reported MSP at three or more sites in past month were 38.22%. The three most common sites were neck (42.15%), shoulder (37.31%) and feet (36.28%). Psychological distress was more strongly associated with multisite MSP as compared to work-related factors, after controlling for potential confounders, i.e., age, gender, ethnicity, Body Mass Index, marital status and education level. Psychological distress symptoms like anxiety displayed the highest odds (Odds Ratio (OR) 2.27; 95% Confidence Intervals (95% CI) 1.97 to 2.63), followed with depression (OR 1.43; 95% CI: 1.15 to 1.78) and stress (OR 1.35; 95% CI: 1.03 to 1.76). The work-related factors with statistical significant findings were administrative duties (<4 hr/day) (OR 1.37; 95% CI: 1.12 to 1.68), teaching (<15 years) (OR 1.21; 95% CI: 1.00 to 1.47) and high psychological job demand (OR 1.05; 95% CI: 1.04 to 1.07). Other work-related factors did not show any association.The study found that psychological distress, i.e., anxiety, depression and stress have stronger association with multisite MSP. Intervention to reduce multisite MSP should include psychological distress along with the improving work processes.