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Background. The presence of widespread pain is simple to determine and is known to increase risk for persistent symptoms. Objective. We hypothesized that persons with minimal or no knee osteoarthritis and high WOMAC Pain scores would be more likely to report widespread pain than other subgroups. Design and Methods. We used data from the Multicenter Osteoarthritis Study (MOST), a multi-center study of people with or at high risk for knee OA. A total of 755 persons with unilateral knee pain and 851 persons with bilateral knee pain met our inclusion criteria. Widespread pain was assessed by use of body diagrams and radiographic Kellgren and Lawrence grades were recorded for each knee. The WOMAC Pain score quantified knee pain with daily tasks. Results. A higher proportion of persons in the high knee pain/low knee OA subgroup had widespread pain as compared to the high pain/high knee OA, low pain/high knee OA and low pain/low knee OA subgroups, particularly for persons with bilateral knee pain (relative risk estimates ranging from 1.7 (95%CI=1.2, 2.4) to 2.3 (95%CI = 1.6, 3.3)). Limitations. The cross sectional design is a limitation of the study. Conclusions. Patients with either no or minimal knee OA and high knee pain with daily tasks ar