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We compared the prevalence of chronic back pain (CBP) at two points 4 years apart and examined socio-demographic, health, and pain-related factors associated with its onset and persistence.A random population sample of 2,184 adults was surveyed in 1996 and resurveyed in 2000. The questionnaire included chronic pain case definition questions (pain for 3 months or longer); the cause (1996) or site (2000) of any chronic pain; the Chronic Pain Grade questionnaire; the Level of Expressed Need (LEN) questionnaire; the SF-36 general health questionnaire; and demographic questions. Those with CBP in 1996 and 2000 had “persistent” CBP; those with CBP in 1996 but not 2000 had “recovered” CBP; those with CBP in 2000 but not 1996 had “new” CBP.Corrected response rates were 82.3% (1996) and 83.0% (2000). The sample prevalence of CBP was 16% (1996) and 27% (2000). Factors in 1996 independently associated with “persistent” compared with “recovered” CBP were preexisting arthritis, high LEN, poor mental health, and not living alone. Factors independently predicting “new” CBP compared with no previous CBP were previous chronic pain elsewhere and poor physical health. “Persistent” CBP was associated with more severe pain, higher LEN, and poorer general health than “new” CBP.CBP is a common and lasting problem, whose persistence and onset are predicted by clinical (especially pain) and help-seeking behavior factors, rather than socio-demographic. Prevention should focus on these factors.