Widespread pain (WSP) is common in the general population and is associated with poor outcomes. The aim of this study was to quantify the risk for medically certified disability pension from WSP. We further studied how other common physical symptoms, common mental disorders and functional limitations influenced this risk. A prospective cohort design was established by linking the large population based Hordaland Health Study (n > 18000 individuals aged 40-46) with an administrative registry on disability pension awards. We modelled hazard ratios for later all-cause and diagnosis specific disability pensioning from WSP, adjusted for potential confounders and examined the impact of other co-occurring health problems and functional limitations. WSP was common (12.4%) and associated with a range of mental health, and non-specific and non-musculoskeletal symptoms. As expected, WSP was a strong predictor for disability pension award. Hazard ratios (HR) adjusted for socio-economic status, health behaviours and comorbid medical diagnoses indicated WSP was strongest in predicting pensioning for musculoskeletal diagnoses (HR = 5.91, 95% CI 4.64-7.54), but also predicted pensioning for mental disorder (HR = 3.13, 95% CI 2.20-4.46) and other diagnoses (HR = 1.81, 95% CI 1.30-2.51). Further adjustments for other common symptoms, including mental illness, reduced, but did not abolish these risks. WSP is a major risk factor for disability pensions, and not only pensions for musculoskeletal disorders. The global impact of WSP, and its close association to other symptoms, suggests prevention of the severe occupational outcomes for this group must have a broad focus and move beyond symptom directed approaches.