Background: Spine pain is one of the most common and costly health problems in developed countries. The purpose of this study was to analyze the structural equation modeling the effect of resilience and pain coping strategies on pain perception in patients with spinal pain: mediated by psychological symptoms. Methods: This study was a correlation study using structural equation modeling. The statistical population of the study was all patients with spinal pain referred to Shams Hospital in Tabriz in 2018, estimated to be 750 patients. The statistical sample of the study was 254 people selected by available sampling based on Krejcie and Morgan’s table. The data gathering tool was the SCL-90 questionnaire, Pain Coping Strategies Questionnaire, Resiliency Scale, and new questionnaire (MPQ). The data were analyzed using structural equation test in Amos software and Bootstrap test. Results: The results of structural equation modeling analysis showed that direct paths from irradiation to pain perception (β=0.000, P<0.01) were significant. There is a direct correlation between coping strategies and pain perception (β=0.31, P<0.01). There is an indirect relationship between vibration, psychological symptoms, and pain perception (β=0.139, P<0.01) There is an indirect relation between coping strategies, psychological symptoms, and pain perception (β = 0/25, P<0.01) Conclusion: It is recommended to develop a comprehensive care plan for patients with spinal pain by enhancing resilience and coping strategies to reduce the level of psychological symptoms in these patients.