Purpose: Many older patients with common chronic conditions also experience chronic pain. We examined how chronic pain affects patients' difficulty with recommended self-management activities and the potential intervening role of self-efficacy (the level of confidence in one's own ability to perform a specific task). Design and Methods: We obtained data from a cross-sectional nationwide survey of older patients, primarily older men, with chronic health conditions (N = 543). We defined chronic pain as pain present most of the time for 6 months or more during the past year. We assessed ability to follow self-management recommendations by asking respondents to rate their level of difficulty in performing three commonly recommended activities as suggested by their doctor. Results: More than 60% of survey respondents reported chronic pain. Chronic pain was significantly associated with difficulty exercising regularly (odds ratio [OR] = 1.57, 95% confidence interval [CI] = 1.04-2.37) and taking prescribed medications (OR = 3.08, 95% CI = 1.10-8.59) but not with following a recommended eating plan (OR = 1.16, 95% CI = 0.76-1.76). However, when we took self-efficacy into account, chronic pain was no longer significantly associated with either exercise or taking medications. Implications: Chronic pain is a prevalent condition among older patients and is associated with greater reported difficulty performing certain essential self-management activities. Self-efficacy, however, plays an important intervening role. Specifically, higher self-efficacy negated or reduced the association between chronic pain and reported difficulty exercising and taking medications. Promoting self-efficacy among older adults with multiple chronic health problems is a promising strategy to improve their ability to follow self-management recommendations.