As demonstrated in numerous studies, psychological distress and musculoskeletal pain commonly occur together; psychological distress is associated with a poor prognosis of musculoskeletal pain; and psychological distress is prognostic for a poor response to treatment. Research in this field is in need of better conceptual and theoretical underpinnings: the field is moving from empirical demonstrations of the impact of distress on pain towards better understanding of how psychological distress affects musculoskeletal pain and how psychological distress can be addressed during treatment. The overall goal of this symposium is to contribute to the theoretical understanding of the role of psychological distress in musculoskeletal pain, by summarizing recent developments in research and treatment.