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Knee osteoarthritis is a leading cause of chronic pain in adults (1, 2). Yet its impact varies (3, 4), and may be influenced by changes in the central nervous system (5, 6), similar to neuroplasticity observed in aging (7, 8), including increased brain atrophy, placing individuals at a greater risk for negative outcomes (9). We used an established brain age biomarker (brain-PAD) in a diverse cohort of middle aged and older adults with various levels of knee OA pain and related disability (10, 11). We hypothesized that 1) brain-PAD would differ between those with/without pain, 2) those with high-impact pain (i.e., pain with physical limitation) would present with a greater brain-PAD (i.e., older-appearing brain reflective of greater age-related brain atrophy), and 3) that brain-PAD would be associated with pain and psychosocial characteristics. Here, 202 adults with/without knee OA pain (mean age = 58.2 ± 8.2, 65.5% female …