Fear and avoidance remain important concepts for understanding chronic pain. The objective of our research was to develop and evaluate a Polish version of a measure to assess these concepts: the 20-item Pain Anxiety Symptoms Scale (PASS-20). The goal also included establishing a cutoff score to differentiate between individuals with a high level of pain-related disability and those with lower levels. The scale underwent back-translation into Polish, and two studies were conducted among individuals reporting chronic pain: in a large online sample (N = 418; 60% women, 40% men; age: 19–86, M = 49), and in a hospital-recruited sample (N = 148; 77% women, 22% men; age: 18–85; M = 57). We assessed validity, internal consistency, and test–retest reliability. Confirmatory factor analyses supported both a model with four correlated factors—cognitive anxiety, physiological responses, avoidance, and fearful thinking—and a hierarchical model with four lower order factors and a higher order factor representing general pain anxiety. There was no evidence of ceiling or floor effects. Cronbach’s αs exceeded .82 and .76 for the online and hospital-recruited samples, respectively, indicating robust internal consistency. The translated PASS-20 scores showed moderate test–retest reliability and positively correlated with pain catastrophizing, depression, stress, anxiety, and pain intensity. Women and individuals with disabilities reported higher scores. Receiver operating characteristic analysis determined an optimal cutoff score of 52 or above to distinguish highly disabled individuals with 82.35% sensitivity and 58.86% specificity. A minimal detectable change of 26.81 for the PASS-20 total score was identified. The Polish PASS-20 provides valid and reliable scores for measuring pain-related anxiety.