Why is the pain associated with osteoarthritis so difficult to manage? When we understand the answer to this question, addressing it becomes easier although still challenging. OA is characterised by a mix of acute and chronic pain. It is the complexity, the multi-mechanistic nature and the duration of the pain that tests us. Pain is poorly related to the extent of local pathology suggesting we regard it as a separate disease requiring separate treatment, although the disease in the joint both initiates and sustains the pain. So, we need to treat both the joint pathology and the pathology of pain together to better manage pain. We have a wide range of treatments at our disposal for this. But do we use them correctly? Several questions need to be addressed: are we introducing treatment too late? Are we failing to treat for long enough periods? How can we tell if our efforts are effective? This session considers how management could change to take advantage of advances in understanding of pain, new treatments and assessment methods to create a more pragmatic, complete and effective strategy for managing OA.