Background: Psychological research has consistently demonstrated the importance of cognitions in the form of thoughts and images on an individual’s wellbeing. Having pain-related verbal cognitions has been shown to lead to poorer outcomes for patients (McCracken & Turk, 2002). Research in other conditions has shown mental images have a more powerful impact on emotion than verbal cognitions (Holmes & Matthews, 2005). To date however, little work has explored the role of mental imagery in adjustment to chronic pain. Methods Fourteen semi-structured interviews were conducted with individuals with chronic pain. Interview transcripts were analysed according to grounded theory methods to construct a substantive theory of the impact spontaneously-invoked images of pain have on functioning. Results Eight participants reported pain-related imagery and three reported mental images associated with related symptoms. In line with previous findings (Gillanders et al., 2012; Gosden, 2008) the frequency and intensity of pain-related images influenced the degree of distress experienced. There was a distinction made between intrusive mental images and visual descriptions or metaphors of pain. The former being conceptualised as a visual cognition and playing a role in the aetiology and maintenance of distress in chronic pain and therefore an adverse impact on functioning. Conclusion Enhancing our understanding of pain related imagery and its impact on functioning could inform the design of interventions in clinical practice. Working systematically with patients’ idiosyncratic pain related images and the beliefs that are associated with them could be a helpful specific target for therapy.

The purpose of the present study was to investigate cognitive functioning in a group of 30 chronic pain patients (CPG) as compared to a group of 39 acute pain patients (APG). In order to assess cognitive performance, certain subtests were selected from the McCarron-Dial System (MDS) of Neuropsychological Evaluation. Specifically, a measure of haptic discrimination was used along with the Bender Visual Motor Gestalt Test. As such, completion of these subtests required a cortically mediated, central nervous system processing of sensory information. This particular method of assessment was chosen because it provided a nonverbal measure of higher-order cognitive performance. Additionally, the haptic measure provided separate scores for right and left hemispheric functioning. Data analysis revealed significantly poorer Bender performance among CPG members (t(69) = -5.09, E - •0004, two tailed). Further data analysis revealed that the CPG performed significantly poorer on certain of the haptic discrimination subtests. Specifically, both texture and configuration scores for the right hemisphere were significantly lower among CPG members (texture, p = -042 and configuration, p = .002). Subsequent analyses were conducted to determine predictive relationships between important variables. These data are discussed in terms of their clinical significance and importance for future research.