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Cross-sectional survey.To measure the association between physical and psychosocial factors, and symptoms of back pain after major physical injury. The study was conducted at a major metropolitan trauma center.Persistence of back pain has been associated more with psychosocial factors, such as job satisfaction and stress, than with physical factors, such as injury characteristics. Predictors of back pain after major accidental, non–self-inflicted injury have not previously been reported.Consecutive adult patients presenting to a single institution with accidental major trauma over a 5-year period were surveyed between 1 and 6 years postinjury (mean, 41 months; range, 12–74 months). Data pertaining to general factors, injury severity, and psychosocial factors were gathered from the hospital trauma registry and the follow-up questionnaire. The main outcome was symptomatic back pain at follow-up derived from the SF-36 bodily pain subscale. Multivariate analysis was performed to determine which factors were independently associated with back pain at follow-up.Back pain after major trauma was not associated with measures of injury severity, such as the Injury Severity Score or the presence of a spinal fracture. Back pain was also not associated with patient-specific factors, such as age, gender, or occupation. Back pain was significantly associated with the presence of posttraumatic stress disorder, the use of a lawyer, the presence of chronic illnesses, and lower education levels.This study highlights the importance of psychosocial factors as predictors of symptomatic back pain after major physical trauma. The findings do not support physical factors as important contributors to future low back pain.