Images of pain: Exploration of the characteristics and functions of pain-related mental imagery in chronic pain

Abstract

Introduction A recent study by Potter et al. (in submission) reported that many chronic pain sufferers experience a spontaneous mental image of their pain, and that these individuals also report higher levels of anxiety and depression. However, little is known about the nature of pain-related mental imagery or the role it might have in chronic pain problems. Research Aims This project aimed to replicate these findings with a larger sample, and to discover more about the characteristics of pain-related mental imagery. It also aimed to explore the possible function of mental imagery in inducing physiological arousal and negative emotional reactivity. Methodology The research consisted of two discrete studies. In the first study, questionnaire measures of mental imagery, pain self-report, depression, anxiety, and use of imagery in everyday life were obtained from a naturalistic sample of chronic pain sufferers (N=105). The second study interviewed fourteen participants who reported experiencing pain-related mental imagery. These participants were also asked to intentionally generate their image and subjective measures of physiological and emotional reactivity were recorded. Results A significant proportion (40%) of participants reported experiencing pain-related mental imagery. Those who did also reported significantly higher levels of depression, though a trend towards higher levels of anxiety was not statistically significant. Mental images were predominately reported to be distressing, to occur frequently (at least every day), to interfere with daily living, to be longstanding (on average of three years duration), and to be largely stable over time. The majority of participants who were asked to intentionally self-generate their image during interview reported increases in physiological arousal and negative emotional reactivity. Discussion Experiencing a mental image of pain is a common phenomenon among chronic pain sufferers. Furthermore, the images experienced are long-standing, stable, and appear to be linked with physiological and negative emotional reactivity. It therefore seems possible that these images have a role in psychological adjustment to chronic pain for some sufferers and may contribute to long-term distress and disability. These findings suggest that a greater understanding of pain-related mental imagery may contribute to the psychological assessment and treatment of chronic pain sufferers.