Occupational injury rates among hotel workers exceed the national service sector average. This study assesses the prevalence of back and neck pain, and its associations with physical workload, ergonomic problems, and increasing work demands. Nine hundred forty-one unionized hotel room cleaners completed a survey about health and working conditions. Associations between job demands and pain were determined by logistic regression models adjusting for individual characteristics, cumulative work demands, care-taking responsibilities at home, and psychosocial job factors. The 1-month prevalence of severe bodily pain was 47% in general, 43% for neck, 59% for upper back, and 63% for low back pain. Workers in the highest exposure quartiles for physical workload and ergonomic problems were between 3.24 and 5.42 times more likely to report severe pain than workers in the lowest quartile. Adjusted odds ratios for work intensification ranged from 1.74 (upper back) to 2.33 (neck). Most room cleaners experience severe back or neck pain. Severe pain showed strong associations with physical workload, work intensification, and ergonomic problems.