BACKGROUND: Expanded distribution of pain is considered a sign of central sensitization (CS). The relationship between recording of symptoms and CS in people with knee osteoarthritis (OA) has been poorly investigated. OBJECTIVE: To examine whether the area of pain assessed using pain drawings relates to CS and clinical symptoms in people with knee OA. DESIGN: Cross-sectional study. METHODS: Fifty-three subjects with knee OA scheduled to undergo primary total knee arthroplasty were studied. All participants completed pain drawings using a novel digital device, self-administration questionnaires and were assessed by quantitative sensory testing. Pain frequency maps were generated separately for women and men. Spearman's correlation coefficients were computed to reveal possible correlations between the area of pain and quantitative sensory testing and clinical symptoms. RESULTS: Pain frequency maps revealed enlarged areas of pain, especially in women. Enlarged areas of pain were associated with higher knee pain severity (rs= .325, P < 0.05) and stiffness (rs=.341, P < 0.05), lower pressure pain thresholds at the knee (rs=-.306, P < 0.05) and epicondyle (rs=-.308, P < 0.05) and higher scores with the Central Sensitization Inventory (rs=.456, P < 0.01). No significant associations were observed between the area of pain and the remaining clinical symptoms and measures of CS. LIMITATIONS: Firm conclusions about the predictive role of pain drawings cannot be drawn. Further evaluation of the reliability and validity of pain area extracted from pain drawings in people with knee OA is required. CONCLUSION: Expanded distribution of pain was correlated with some measures of CS in individuals with knee OA. Pain drawings may constitute an easy way for the early identification of CS in people with knee OA, but further research is required.