Momentary assessment of mental imagery and pain-related psychological factors in youth with chronic pain

Mental imagery is a powerful cognitive process implicated in various psychological disorders, yet its role in chronic pain remains underexplored. This study examined the temporal relationship between mental imagery, pain-related psychological constructs, and pain outcomes in young adults with chronic pain. A sample of 121 university students with chronic pain completed baseline assessments of mental imagery (tendency, ability, intrusive imagery), pain-related psychological constructs (interpretation bias, fear of progression, pain anxiety), and general psychological constructs (depression, anxiety, stress, emotion regulation difficulties, trauma symptoms). Participants then completed an ecological momentary assessment delivered by smartphone app 3 times daily for 1 week, reporting on pain severity, pain interference, pain-related imagery (frequency, valence, vividness), and pain expectancy. Multilevel and cross-lagged models were used to assess within- and between-person predictors of pain outcomes. We found that pain-specific imagery, particularly intrusive imagery at baseline and momentary imagery frequency, was consistently associated with greater pain severity and interference, and predicted subsequent pain severity. General imagery tendency was inversely associated with pain outcomes, suggesting a potential protective effect. Increased pain imagery valence and vividness were differentially associated with increased pain severity and interference, respectively. Pain expectancy, interpretation bias, and fear of progression were also significant predictors of pain interference, while pain expectancy also predicted subsequent pain severity. These findings suggest that pain-specific mental imagery is a temporally relevant and potentially modifiable predictor of pain outcomes in young adults.