The paper reviews the concept of fear-avoidance in chronic musculoskeletal pain, highlighting its role in the development and maintenance of chronic pain disability. The fear-avoidance model, introduced by Lethem et al., posits that fear of pain leads to either confrontation or avoidance, with the latter exacerbating fear and potentially leading to a phobic state. The paper discusses the precursors of pain-related fear, including negative appraisals, negative affectivity, and anxiety sensitivity. It also explores fear-related processes such as escape and avoidance behaviors, hypervigilance, muscular reactivity, and physical disuse. The assessment methods for quantifying pain-related fear and avoidance are reviewed, and the implications for prevention and treatment are discussed. Despite ongoing research gaps, the paper concludes that pain-related fear and avoidance are essential features in the development of chronic musculoskeletal pain.The paper reviews the concept of fear-avoidance in chronic musculoskeletal pain, highlighting its role in the development and maintenance of chronic pain disability. The fear-avoidance model, introduced by Lethem et al., posits that fear of pain leads to either confrontation or avoidance, with the latter exacerbating fear and potentially leading to a phobic state. The paper discusses the precursors of pain-related fear, including negative appraisals, negative affectivity, and anxiety sensitivity. It also explores fear-related processes such as escape and avoidance behaviors, hypervigilance, muscular reactivity, and physical disuse. The assessment methods for quantifying pain-related fear and avoidance are reviewed, and the implications for prevention and treatment are discussed. Despite ongoing research gaps, the paper concludes that pain-related fear and avoidance are essential features in the development of chronic musculoskeletal pain.