BACKGROUND: Patients with somatoform pain disorders (SPD) frequently display reduced quality of life (QoL) and increased levels of alexithymia. This study investigated the association of QoL and alexithymia in a sample of SPD. PATIENTS AND METHODS: Fifty-one patients with SPD (average time since onset: 11.6 years) were assessed in terms of alexithymia (TAS-20), QoL (WHOQOL-BREF), psychological distress and somatisation (SCL-90-R), and depression (MADRS). RESULTS: In SPD patients a significant negative correlation was observed between QoL and alexithymia, particularly the psychological domain of QoL and the TAS-20 total score (r=-.63, p<.001). The TAS-20 subscale "Difficulty Describing Feelings" was revealed to be a significant predictor of the psychological domain of QoL (beta=-.34, p<.01), even after controlling for depression, somatisation and gender. CONCLUSION: Patients with SPD show a remarkably reduced QoL and alexithymia appears to play a significant role for low QoL. Clinicians need to pay careful attention to alexithymia with regard to diagnosis and treatment planning in SPD patients.