Lately, cognitive behavioral models have put forth that the co-occurrence of pain and stress might be explained by mutually maintaining psychological mechanisms such as catastrophizing and avoidance. This study aimed to map the interrelationship between pain, stress, catastrophizing, cognitive, and behavioral avoidance across time. A general population sample (n = 551) was followed from baseline to 3-month and 1-year follow-up. The results revealed subgroups with stress and pain in combination as well as in isolation. The subgroups were highly stable across time, and catastrophizing, cognitive, and behavioral avoidance were related to the development of symptoms. The results support that shared, but also specific cognitive and behavioral, processes may maintain and drive the development of pain and stress problems.