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A systematic review of evidence about the role of alexithymia in chronic back painIndividuals with alexithymia struggle to make sense of their emotions. Alexithymia has been associated with a range of physical illnesses, but may influence different illnesses differently, so to understand the role of alexithymia in illness it is important to focus on specific conditions. This article reviews evidence from ten reports published between 2000 and 2018 of studies with samples of adults with chronic back pain that used the Toronto Alexithymia Scale (TAS). The studies were conducted in Germany, Israel, Italy, Russia, Turkey and the USA. Eight studies involved clinical samples and two involved public transit workers. Studies that compared participants with high and low alexithymia consistently found associations with measures of pain. The findings show that more severe alexithymia plays a role in the experience of chronic back pain, and support the incorporation of alexithymia-related elements in interventions to help people with chronic back pain improve their emotional regulation and reduce their pain-related distress.