Psychosocial factors are at least as important as biomedical factors in the onset, maintenance, and treatment of chronic low back pain. This article reviews some of the common psychosocial factors that influence the course of pain from acute to chronic status, cognitive behavioral interventions used to alter dysfunctional pain cognitions, and avoidance behaviors and the emotional distress that can accompany pain and pose barriers to recovery. The interplay of cognitive, emotional, behavioral, biomedical, and social factors is described using a fear avoidance model. Interdisciplinary pain rehabilitation is discussed as an effective option for more biopsychosocially complex patients.