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Objectives This study aimed to estimate the prevalence of pain medication use and to examine associated factors among older adults with activity-limiting pain.Methods We conducted a cross-sectional analytical study using data from Longitudinal Ageing Study in India (LASI Wave 1, 2017–2018). Adults aged ≥45 years who reported pain interfering with usual activities in the past month were included (N=15 587, females 64.2%). Descriptive statistics and weighted log-binomial regression models using survey weights were applied for the analysis.Results The prevalence of pain medication use was 76.6% (n=11 694; 95% CI 75.5% to 77.7%). Analgesics were the most used (46.02%; CI 44.68% to 47.35%), followed by local/external applications (45.21%; CI 43.85% to 46.58%) and therapy-based interventions (8.06%; CI 7.48% to 8.69%). Analgesic use ranged from 3.33% in Sikkim to 68.33% in Telangana. Medication use for pain was higher among those aged 60–74 years (prevalence ratio (PR): 1.05; CI 1.00 to 1.10), richest wealth quintile (PR: 1.12; CI 1.07 to 1.17), urban residents (PR: 1.05; CI 1.01 to 1.09), Hindus (PR: 1.17; CI 1.09 to 1.26) and those with bone/joint disease (PR: 1.10; CI 1.07 to 1.13). Analgesic use was higher among those aged 45–59 years, rural residents, middle wealth quintile, Muslims and those with gastrointestinal disorders.Conclusions Over three-fourths of older Indian adults with activity-limiting pain reported using medications. Strengthening equitable access to comprehensive, multimodal pain-management approaches within supportive and palliative care frameworks is essential to improve quality of life in this population.