Intrusive Mental Imagery in Chronic Pain: Prevalence and Associations with Common Comorbidities

Abstract

Abstract Purpose Chronic pain is a highly prevalent and distressing condition with limited treatment efficacy. Prior research reports associations between the experience of mental imagery about chronic pain and pain itself, particularly in those with anxiety and depression. However, many aspects of these associations remain unexplored. A better understanding could help improve cognitive-behavioural therapies for chronic pain. This study aimed to describe the prevalence of intrusive pain-related mental imagery in a sample of people with chronic pain, examine the extent to which this imagery explained variation in pain intensity and disability, and examine the association between negative interpretations of imagery and pain. Method A cross-sectional online survey was conducted. Participants with chronic pain (n = 151) completed standardised measures of anxiety, depression, health anxiety, general imagery use, and an adapted questionnaire about intrusive pain-related imagery. Results Intrusive pain-related imagery was present in 52.3% of the sample. Demographic variables, anxiety, depression, and health anxiety significantly explained 19% (p < .001) of the variation in pain intensity and 20.2% (p < .001) in pain disability. The presence/absence of intrusive pain-related imagery did not significantly explain any additional variance for either outcome. However negative interpretations of imagery explained additional variance in pain disability. Intrusive imagery was interpreted negatively, experienced as moderately distressing, and was associated with higher rates of anxiety, depression and health anxiety. Conclusions Experiencing intrusive imagery about pain is common, but its presence or absence appears to have no direct relationship on pain intensity or disability. The relationship is likely to be more complex, warranting further investigation. Negative interpretations of imagery represent a potential treatment target amenable to intervention.