Knee pain is a major source of disability in patients with knee osteoarthritis (OA). Although the mechanism of OA progression has been well documented, pain pathophysiology is largely unknown. Recent accumulating clinical evidence indicates that subchondral bone marrow lesions (BMLs) detected on MRI in knee OA are strongly associated with intense pain. In this review we describes bone pain in knee osteoarthritis clarified by our basic and clinical studies.