Why Does My Arthritis Hurt So Much? Understanding the Complexity of Pain
If you have osteoarthritis (OA), you may have wondered?
“Why does my knee hurt so much when someone else has the same arthritis and barely hurts at all?”
Or maybe you have tried medications, injections, weight loss, rest, or other treatments and thought:
“Why isn’t this working for me?”
A new review in Nature Reviews Rheumatology helps explain why the answer isn’t always as simple as “your joint is damaged, so it hurts.”
Pain is more complicated than what shows up on an X-ray
For years, we have often thought about arthritis pain primarily as a problem inside the joint.
But pain is influenced by much more than the condition of the joint itself.
Researchers describe OA pain as the interaction of multiple systems, including:
The joint and surrounding tissues
Inflammation and the immune system
The nervous system and how strongly it responds to signals
Sleep and physical activity
Psychological factors
Social factors and life circumstances
Genetics and other biological factors
In other words, two people can have similar-looking arthritis but experience very different amounts of pain. (Nature)
This does NOT mean your pain is “in your head.”
This is an important distinction.
Pain is real.
Your nervous system is part of your body’s protection system. When pain has been present for a long time, that system can become more sensitive, meaning the brain and nervous system may respond more strongly to signals coming from the body.
That doesn’t mean the pain is imaginary.
It means that the volume knob on the pain system can be turned up or down.
And that helps explain why simply treating the joint doesn’t always eliminate the pain.
Why doesn’t the same treatment work for everyone?
The authors describe two broad patterns of OA pain.
Some people have a more localized, lower-complexity pain profile, where the joint itself is the primary driver. These individuals may respond relatively well to traditional treatments.
Others have a higher-complexity pain profile, where joint problems interact with nervous-system sensitivity, inflammation, sleep, psychological factors, genetics, and other influences. These individuals may be less likely to respond to a single treatment approach. (Nature)
That may help explain why one person feels dramatically better after an injection while another gets very little relief.
Or why one person responds well to weight loss or medication while another continues to struggle.
So what can you actually do?
The good news is that you are not limited to treating the pain itself.
We can work on the things that influence your ability to move and function.
That might include:
🏋️ Building strength
Stronger muscles can improve your ability to perform everyday activities and increase your physical capacity.
🚶 Increasing physical activity
Movement is not simply something you do despite arthritis. Appropriate exercise can be part of the treatment.
😴 Improving sleep
Poor sleep can increase pain sensitivity and make it harder to recover.
⚖️ Addressing weight when appropriate
Weight management can be beneficial for some people with OA, but it is only one piece of a much bigger picture.
🧠 Changing how you think about movement and pain
Fear of movement can lead to avoiding activity, which can gradually reduce strength and confidence. Learning what your body can safely tolerate can help break that cycle.
🎯 Finding the right dose
There is no single “arthritis workout.” Your exercise program should be adjusted to your symptoms, abilities, goals, and current capacity.
The goal isn’t always “make the pain disappear.”
Sometimes the better question is:
“How can we make you stronger, more capable, and more confident—even if some pain is still present?”
That is an important shift.
Your X-ray doesn’t tell us everything about your pain.
Your pain doesn’t tell us everything about the condition of your joint.
And having arthritis doesn’t mean you have to stop doing the things you enjoy.
At Southern Grit, we believe the goal is to help you build capacity for life—whether that means walking farther, getting up and down from the floor, climbing stairs, traveling, playing with your grandchildren, or simply feeling confident in your body again.
Pain is complex. Your treatment can be, too.
The Research
Petersen, K. K.-S., Ciampi de Andrade, D., Pickering, G., et al. The complexity of pain in osteoarthritis.Nature Reviews Rheumatology. 2026;22:378–389. (Nature)
