Abstract Background: In France, budgetary constraints on the healthcare system have led to difficulties in access to care. Objectives: To evaluate whether difficulties in access to general practitioners (GP) or physiotherapists (PT) is associated with higher prevalence of chronic musculoskeletal pain Methods: This is a cross-sectional study nested in the Constances prospective cohort. The Constances cohort included people aged 18 to 69 with a selection representative for age, gender and socioeconomic status of the French adult population. All patients had to fill self-administered questionnaires at inclusion, with information related to demographics, medical symptoms, habitus, social and professional parameters. After excluding cancer, people who suffered from low back, neck, shoulder and knee pain lasting more than 30 days in the last 12 months were selected. Access to GP and PT at the local level was calculated via a proxy estimated based on nearby available medical resources (GP and PT density in the county) and the expected population health needs calculated by the percentage of older people people. The proxy resulted in 3 levels of access (LoA) - severe shortage area (SSA), moderate shortage area (MSA) and adequately served area (ASA) – for access to GP and PT, separately. The number of consultations (or months of care for PTs) was established via claims registered in the national health insurance database. Distribution difference between LoA groups were tested by Kruskal-Wallis test. Factors associated with the observed differences were identified by uni-then multivariate analysisafter adjustment on sex, age, comorbidities, BMI, depression, leisure and occupational physical activity, consumption of alcohol, tobacco or cannabis, diploma, socio-economic category and household income. Results: Overall, 193,436 participants were included. The distribution of LoA groups for GPs was: 5% for SSA, 32% for MSA and 62% for ASA. The distribution of groups of accessibility for PTs was: 5% for SSA, 28% for MSA and 65% for ASA. The number of consultations in the last 12 months was significantly different in the three groups (3.32, 3.65 and 3.69 respectively for GPs, p<0.001, and 0.59, 0.73 and 0.83 respectively for PTs, p<0.001). Prevalence of low back pain was significantly different between SSA, MSA and ASA for GP (27.5%, 25.9% and 23.0% in the three groups respectively). After adjusting for confounding factors, only MSA remained significantly associated (OR =1.03 [1.00-1.06]) to GPs access. Prevalence of low back pain was also significantly associated to PTs access (29.1%, 26.4% and 22.8% respectively), and remained significantly associated after adjusting for cofounding factors (OR=1.06 [1.03-1.09] for MSA and 1.13 [1.07-1.20] for SSA). Concerning neck, shoulder, hand or elbow but not knee, access to PTs was associated to reduced prevalence of chronic MSK pain after adjustment of confounding factors (Table 1). Table 1. Association between pain prevalence and access to GPs of PTs after adjusting of cofounding factors. Results are odds ratio with 95% confident interval. Significant odds ratio are in bold.