Psychosocial factors have become increasingly recognized as important moderators and determinants of the pain experience. There are a number of variables that tap into a negative pain schema, including pain anxiety, pain helplessness, and fear of pain. These share a significant variance compared with broader negative affect constructs, such as depression and anxiety. Fear is the emotional reaction to a specific, identifiable, and immediate threat, such as an injury. Fear can lead to avoidance of activities that people with chronic pain associate with the occurrence or exacerbation of pain. While avoidance can be adaptive in the acute phase, continued avoidance during the chronic phase can lead to distress, disability, and increased absenteeism and healthcare utilization. The fear avoidance model (Lethem et al, 1983) describes how individuals develop chronic musculoskeletal pain as a result of avoidant behavior based on fear. A question remains: If fear drives disability then could severe disabling pain make one fearful? Fear avoidance beliefs can be assessed using several different questionnaires that will be delineated in the presentation. Assessment of pain related fear is recommended because treatment may only be appropriate for patients who are more likely to be avoiders. Graded activity is an effective strategy to regain physical fitness and concurrent positive effects on cognitive factors. Focusing on the cognitive factors by using cognitive behavioral therapy directly may foster stronger effects. Other mind-body approaches, such as guided visualization, meditation, yoga, and similar holistic techniques can be an effective adjunct to treating fear avoidance.