Pain is a common and disabling symptom experienced by many patients with rheumatic conditions. The underlying pathophysiology leading to pain is not fully understood and symptoms often persist despite optimal medical intervention. The pain experienced by a patient is not simply linearly related to the nociceptive input, but is a combination of emotional, cognitive and sensory factors.

Neuroimaging is a powerful tool, which has been used to investigate the neural bases of pain. This method has enabled the discovery of several cortical and sub-cortical areas ( in the brain) , which are thought to be important in pain perception. The use of neuroimaging in patients with chronic pain has demonstrated considerable disruption of the normal structure and function of these brain regions.

In Osteoarthritis ( OA) , there is increasing evidence to support the role of centrally mediated factors in the generation of pain. Neuroimaging provided the *first direct evidence of central sensitization in OA. This has implications on the optimization of medical and surgical treatment in OA.

The placebo ( and nocebo) effect has received much attention in recent years and neuroimaging has been used to investigate the underlying mechanism of this phenomenon.These studies support the involvement of frontal-limbic-brainstem network capable of driving endogenous ( the body’s own internal processes) opioid and dopamine release. These studies may inform methods to optimize treatment outcomes in clinical practice.

These studies presented by A. Soni at the EULAR meeting Rome 2015 from Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences,University of Oxford, Oxford, United Kingdom