Background: Little empirical evidence is available on differential associations between social status indicators and back pain in Germany. This study therefore systematically evaluated associations between different indicators of social status and back pain. Methods: In total 4,412 employed adults, aged 18 to 65 years participated in a postal survey in 5 regions of Germany. The point prevalence and 1-year prevalence of back pain were assessed as well as the level of disabling back pain. Educational level, professional category and household income served as measures of social status. Associations between social status and back pain have been assessed cross-sectionally using Poisson regression. Results: Educational level was the best predictor for back pain among the assessed social status indicators. Adults with a low educational level had almost a 4-fold risk of reporting disabling back pain compared to subjects with a high educational level. Associations were highest for disabling back pain and attenuated strongly over the point prevalence towards the 1-year prevalence. Discussion: Back pain cannot generally be regarded as a symptom of a low social status. However, social inequality is of major importance regarding the prediction of severe back problems. A better understanding of mediating factors is essential for the prevention and therapy.