Chronic pain is common during adolescence and young adulthood and is associated with poor quality of life, depression, and functional disability. Recognizing that chronic pain has significant consequences it is important to identify modifiable health behaviors that may place young adults at-risk for chronic pain. This study examines associations among chronic musculoskeltetal pain and smoking in young adult twins (n=1588, ages 18–30) participating in a statewide twin registry. Twins completed questionnaires assessing smoking, mood (anxiety, depressive symptoms, stress), and chronic musculoskeletal pain. Analyses examined associations among chronic pain and smoking, particularly the role of genetics/shared familial factors and psychological symptoms. As predicted, results revealed a near two-fold increased risk for chronic musculoskeletal pain in twins who currently smoked compared to non-smokers, even when accounting for psychological factors. Results of within-pair analyses were only minimally attenuated suggesting associations among smoking and chronic musculoskeletal pain are better accounted for by non-shared factors than shared familial factors/genetic effects. Future twin research is needed to identify what non-shared factors (e.g., attitudes, direct effects of smoking on pain) contribute to these associations to further understand comorbidity. Longitudinal studies and recruitment of participants prior to smoking initiation and chronic pain onset will better identify causal associations.