Purpose Many older workers are working despite having neck-shoulder pain (NSP), which may give rise to work limitations due to pain, especially among those with high physical work demands. This study investigated the joint association of neck-shoulder pain intensity and physical work demands with work limitations among older workers. Methods In SeniorWorkingLife, workers ≥ 50 years ( n  = 11,800) replied to questions about NSP intensity, work limitations due to pain, and physical activity demands at work. The odds ratio for having a higher level of work limitations due to pain in relation to neck-shoulder pain intensity and physical work demands were modeled using logistic regression controlled for various confounders. Results The results showed that the neck-shoulder pain intensity was associated with work limitations in a dose–response fashion ( p  < 0.0001). Importantly, a significant interaction existed between neck-shoulder pain intensity and physical activity at work ( p  < 0.0001), e.g., 77% of workers with high pain and high work demands experienced work limitations due to the pain. Conclusion Higher neck-shoulder pain intensity and higher physical work demands—and particularly in combination—were associated with higher odds of work limitation due to pain among older workers. Thus, it seems especially important to accommodate work demands through a better work environment for these groups of workers.