Background The objective of this study was to elucidate the relationships musculoskeletal pains with combined vulnerability in terms of age, gender, and employment status Methods The fifth European Working Conditions Survey (EWCS) in 2010 (43,816 participants aged 15 years and over) analyzed for European employees and the third Korean Working Conditions Survey (KWCS) in 2011 (50,032 participants aged 15 years and older) analyzed for Korean employees. In this study, three well known vulnerable factors to musculoskeletal pains (older age, female gender, and precarious employment status) were combined and defined as combined vulnerability. Associations of musculoskeletal pains with combined vulnerability were assessed with prevalence ratios (PRs) and 95% confidence intervals (CIs) estimated by Poisson regression models with robust estimates of variance. Results The prevalences of musculoskeletal pains were lower but the absolute and relative differences between combined vulnerabilities were higher among Korean employees compared with the European employees. Furthermore, the increased risk of having musculoskeletal pains according to combined vulnerability was modestly explained by socioeconomic factors and exposure to ergonomic risk factors, especially in Republic of Korea. Conclusions The results of this study showed that the labor market may be more unfavorable for female and elderly workers in Republic of Korea. Any prevention strategies to ward off musculoskeletal pains, therefore, should be found and implemented to mitigate or buffer against the most vulnerable work population, older, female, and precarious employment status, in Republic of Korea.