Psychological factors are predictive of long term disability for many pain syndromes as well as for pain severity emotional distress and treatment seeking. It is known that fear of pain leads to avoidance of pain-related experiences and contributes to disability.

To determine if there is a significant relationship between optimism/ pessimism, HRQOL and pain in a group of musculoskeletal patients referred to a rehabilitation center, because of chronic pain and mobility difficulties when controlling for fear of pain and pain reduction coping strategies.

The sample consisted of 96 patients. The questionnaires that were used are the Short Form health questionnaire (12 questions; SF12), the Pain Anxiety Symptoms Scale (PASS), the life orientation test-revised (LOT-R) and a VAS scale for pain measurement. Two separate linear regression analyses were conducted to examine the effects of optimism on each of the two main domains of SF12 with optimism entered in the last step of each model.

According to the regression analysis performed, dispositional optimism (β = ,284) is an independent factor affecting the mental composite score in patients with musculoskeletal problems, even after controlling for the effect of pain intensity. Pain -related escape and avoidance is the only factor affecting both physical (β = −,300) and mental health (β = −,192).

The consistent indications that fear is associated with the suffering and disability that often accompany pessimistic patients with chronic musculoskeletal pain, suggests that clinicians working with these individuals should conduct a careful assessment of fear and avoidance, both pain-related and otherwise.