Abstract
Pain imagery is “like having a picture in your head [of your pain] which may include things you can imagine seeing, hearing or feeling.” Pain imagery may offer a unique insight into a patient’s pain experience. This chapter summarises findings from international pain imagery research in women with endometriosis-associated pain. Endometriosis is a chronic inflammatory condition associated with debilitating pain that affects 5–10% of women of reproductive age worldwide. Our international research has found that pain imagery is experienced by around half of women suffering from endometriosis-associated pain, and is associated with higher levels of catastrophising, depression, and anxiety. However, coping imagery is also reported, and prevalent, at 30%. Pain imagery in women with endometriosis falls into themes: sensory qualities of pain; loss of power or control; attack (by someone, “something,” or self); pathology or anatomy envisaged; past or future catastrophe; pain as an object; and abstract images. Imagery content may therefore reveal the meanings of pain or endometriosis to these women. This chapter explores pain imagery content and its personal significance to patients, both for women with endometriosis-associated pain and for patients with other chronic pain conditions. The chapter concludes by discussing the clinical application of imagery, with example patient cases to contextualise the practicalities and therapeutic potential of imagery techniques.
Clinical Implications: Pain imagery was reported by half of women with endometriosis-associated pain in our international study and associated with higher levels of catastrophising, depression, and anxiety. Imagery content is extremely varied but can be categorised into themes, which may offer unique insights into each woman’s pain experience. Coping imagery was prevalent at 30%. We believe imagery techniques may be particularly helpful for women with endometriosis-associated pain and discuss these techniques, which should be of interest to professionals involved in pain management.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsNotes
- 1.
The endometrium is the lining of the uterus (womb) that undergoes cyclical regeneration as it thickens and is later shed during menstruation.
References
Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. Lancet. 1999;354(9186):1248–52.
Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K. The impact of chronic pain in the community. Fam Pract. 2001;18(3):292–9.
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333.
Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an internet-based survey. J Pain. 2010;11(11):1230–9.
National Pain Summit Initiative. National pain strategy: pain management for all Australians [Internet]. 2010 [cited 13/01/2019]. Available from https://www.painaustralia.org.au/static/uploads/files/national-pain-strategy-2011-wfvjawttsanq.pdf
Royal College of Obstetricians & Gynaecologists (RCOG). The initial management of chronic pelvic pain [Internet]. Green-top Guideline No. 41. 2012 [cited 13/01/2019]. Available from https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_41.pdf
Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ. 2014;348:g1752.
Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nat Rev Dis Primers. 2018;4(1):9.
Adamson GD, Kennedy S, Hummelshoj L. Creating solutions in endometriosis: global collaboration through the world endometriosis research foundation. J Endometr. 2010;2(1):3–6.
Hadfield R, Mardon H, Barlow D, Kennedy S. Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Hum Reprod. 1996;11(4):878–80.
Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, et al. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012;27(12):3412–6.
Berna C, Tracey I, Holmes EA. How a better understanding of spontaneous mental imagery linked to pain could enhance imagery-based therapy in chronic pain. J Exp Psychopathol. 2012;3(2):258–73.
Pearson J, Naselaris T, Holmes EA, Kosslyn SM. Mental imagery: functional mechanisms and clinical applications. Trends Cogn Sci. 2015;19(10):590–602.
Kosslyn SM, Ganis G, Thompson WL. Neural foundations of imagery. Nat Rev Neurosci. 2001;2(9):635–42.
McNorgan C. A meta-analytic review of multisensory imagery identifies the neural correlates of modality-specific and modality-general imagery. Front Hum Neurosci. 2012;6:285.
Barber TX, Chauncey HH, Winer RA. Effect of hypnotic and nonhypnotic suggestions on parotid gland response to gustatory stimuli. Psychosom Med. 1964;26:374–80.
Jones GE, Johnson HJ. Physiological responding during self generated imagery of contextually complete stimuli. Psychophysiology. 1978;15(5):439–46.
Jones GE, Johnson HJ. Heart rate and somatic concomitants of mental imagery. Psychophysiology. 1980;17(4):339–47.
Schneider J, Smith CW, Minning C, Whitcher S, Hermanson J. Guided imagery and immune system function in normal subjects: a summary of research findings. In: Kunzendorf RG, editor. Mental imagery. Boston, MA: Springer US; 1991. p. 179–91.
Hirsch CR, Holmes EA. Mental imagery in anxiety disorders. Psychiatry. 2007;6(4):161–5.
Hackmann A, Holmes EA. Reflecting on imagery: a clinical perspective and overview of the special issue of memory on mental imagery and memory in psychopathology. Memory. 2004;12(4):389–402.
Hackmann A, Clark DM, McManus F. Recurrent images and early memories in social phobia. Behav Res Ther. 2000;38(6):601–10.
Patel T, Brewin CR, Wheatley J, Wells A, Fisher P, Myers S. Intrusive images and memories in major depression. Behav Res Ther. 2007;45(11):2573–80.
Di Simplicio M, Renner F, Blackwell SE, Mitchell H, Stratford HJ, Watson P, et al. An investigation of mental imagery in bipolar disorder: exploring “the mind’s eye”. Bipolar Disord. 2016;18(8):669–83.
Somerville K, Cooper M, Hackmann A. Spontaneous imagery in women with bulimia nervosa: an investigation into content, characteristics and links to childhood memories. J Behav Ther Exp Psychiatry. 2007;38(4):435–46.
Holmes EA, Mathews A. Mental imagery in emotion and emotional disorders. Clin Psychol Rev. 2010;30(3):349–62.
Holmes EA, Geddes JR, Colom F, Goodwin GM. Mental imagery as an emotional amplifier: application to bipolar disorder. Behav Res Ther. 2008;46(12):1251–8.
Mathews A, Ridgeway V, Holmes EA. Feels like the real thing: imagery is both more realistic and emotional than verbal thought. Cogn Emot. 2013;27(2):217–29.
Holmes EA, Arntz A, Smucker MR. Imagery rescripting in cognitive behaviour therapy: images, treatment techniques and outcomes. J Behav Ther Exp Psychiatry. 2007;38(4):297–305.
Hackmann A, Bennett-Levy J, Holmes EA. Oxford guide to imagery in cognitive therapy. Oxford: Oxford University Press; 2011. 233 p.
Gosden T, Morris PG, Ferreira NB, Grady C, Gillanders DT. Mental imagery in chronic pain: prevalence and characteristics. Eur J Pain. 2014;18(5):721–8.
Berna C, Vincent K, Moore J, Tracey I, Goodwin GM, Holmes EA. Presence of mental imagery associated with chronic pelvic pain: a pilot study. Pain Med. 2011;12(7):1086–93.
Price DD, Harkins SW. The affective-motivational dimension of pain: a two-stage model. J Pain. 1992;1(4):229–39.
van Rysewyk S. A call for study on the meanings of pain. In: van Rysewyk S, editor. Meanings of pain. Cham: Springer; 2016. p. 1–22.
Philips HC. Imagery and pain: the prevalence, characteristics, and potency of imagery associated with pain. Behav Cogn Psychother. 2011;39(5):523–40.
Gillanders D, Potter L, Morris PG. Pain related-visual imagery is associated with distress in chronic pain sufferers. Behav Cogn Psychother. 2012;40(5):577–89.
Berna C. Mental imagery in chronic pain: an access to meaning beyond words. In: van Rysewyk S, editor. Meanings of pain. Cham: Springer; 2016. p. 267–80.
Gosden T. Images of pain: exploration of the characteristics and functions of pain-related mental imagery in chronic pain. D Clin Psychol [Thesis] [cited 13/01/2019]. Edinburgh: University of Edinburgh; 2008. Available from Edinburgh Research Archive https://www.era.lib.ed.ac.uk/handle/1842/2742
Dworkin RH, Turk DC, Revicki DA, Harding G, Coyne KS, Peirce-Sandner S, et al. Development and initial validation of an expanded and revised version of the short-form McGill pain questionnaire (SF-MPQ-2). Pain. 2009;144(1–2):35–42.
Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524–32.
Pincus T, Williams AC, Vogel S, Field A. The development and testing of the depression, anxiety, and positive outlook scale (DAPOS). Pain. 2004;109(1–2):181–8.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Marks DF. Visual imagery differences in the recall of pictures. Br J Psychol. 1973;64(1):17–24.
Padfield D, Janmohamed F, Zakrzewska JM, Pither C, Hurwitz B. A slippery surface... can photographic images of pain improve communication in pain consultations? Int J Surg. 2010;8(2):144–50.
Padfield D, Chadwick T, Omand H. The body as image: image as body. Lancet. 2017;389(10076):1290–1.
Carruthers HR, Miller V, Morris J, Evans R, Tarrier N, Whorwell PJ. Using art to help understand the imagery of irritable bowel syndrome and its response to hypnotherapy. Int J Clin Exp Hypn. 2009;57(2):162–73.
Carruthers HR, Morris J, Tarrier N, Whorwell PJ. Reactivity to images in health and irritable bowel syndrome. Aliment Pharmacol Ther. 2010;31(1):131–42.
Carruthers HR, Whorwell PJ. Letter: using pictures to improve communication between doctor and patient in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2014;40(11–12):1364.
Henare D, Hocking C, Smythe L. Chronic pain: gaining understanding through the use of art. Br J Occup Ther. 2003;66(11):511–8.
Phillips J, Ogden J, Copland C. Using drawings of pain-related images to understand the experience of chronic pain: a qualitative study. Br J Occup Ther. 2015;78(7):404–11.
Kirkham JA, Smith JA, Havsteen-Franklin D. Painting pain: an interpretative phenomenological analysis of representations of living with chronic pain. Health Psychol. 2015;34(4):398–406.
Jamani N, Clyde Z. Treatment of pain-related fear in chronic (persistent) pain: the role of safety-seeking behaviour and imagery. Cogn Behav Ther. 2008;1(1):3–15.
Chaves JF, Brown JM. Spontaneous cognitive strategies for the control of clinical pain and stress. J Behav Med. 1987;10(3):263–76.
Slade P, Cordle C. Psychological aspects of the management of chronic pelvic pain. Curr Obstet Gynaecol. 2005;15(5):298–305.
Arntz A, Claassens L. The meaning of pain influences its experienced intensity. Pain. 2004;109(1–2):20–5.
Cassell EJ. The phenomenon of suffering and its relationship to pain. In: Toombs SK, editor. Handbook of phenomenology and medicine. Dordrecht: Springer; 2001. p. 371–90.
Bayer TL, Baer PE, Early C. Situational and psychophysiological factors in psychologically induced pain. Pain. 1991;44(1):45–50.
Stewart M. Seeking order amidst the chaos: the role of metaphor within pain reconceptualisation. In: van Rysewyk S, editor. Meanings of pain. Cham: Springer; 2016. p. 325–53.
Scarry E. The body in pain: the making and the unmaking of the world. New York: Oxford University Press; 1985. 400 p.
Achterberg J. Imagery in healing: shamanism and modern medicine. Boston, MA: Shambhala Publications; 2002. 253 p.
Pincus D, Sheikh A. Imagery for pain relief: a scientifically grounded guidebook for clinicians. New York: Routledge; 2009. 311 p.
Hales SA, Di Simplicio M, Iyadurai L, Blackwell SE, Young K, Fairburn CG, et al. Imagery-focused cognitive therapy (ImCT) for mood instability and anxiety in a small sample of patients with bipolar disorder: a pilot clinical audit. Behav Cogn Psychother. 2018;46(6):706–25.
James EL, Bonsall MB, Hoppitt L, Tunbridge EM, Geddes JR, Milton AL, et al. Computer game play reduces intrusive memories of experimental trauma via reconsolidation-update mechanisms. Psychol Sci. 2015;26(8):1201–15.
Hart J. Guided imagery. Altern Complement Ther. 2008;14(6):295–9.
Philips H, Rachman S. The psychological management of pain. New York: Springer; 1996. 286 p.
Posadzki P, Ernst E. Guided imagery for musculoskeletal pain: a systematic review. Clin J Pain. 2011;27(7):648–53.
Posadzki P, Lewandowski W, Terry R, Ernst E, Stearns A. Guided imagery for non-musculoskeletal pain: a systematic review of randomized clinical trials. J Pain Symptom Manag. 2012;44(1):95–104.
Giacobbi PR, Stabler ME, Stewart J, Jaeschke AM, Siebert JL, Kelley GA. Guided imagery for arthritis and other rheumatic diseases: a systematic review of randomized controlled trials. Pain Manag Nurs. 2015;16(5):792–803.
Weydert JA, Shapiro DE, Acra SA, Monheim CJ, Chambers AS, Ball TM. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC Pediatr. 2006;6:29.
Baird CL, Sands L. A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs. 2004;5(3):97–104.
Ilacqua GE. Migraine headaches: coping efficacy of guided imagery training. Headache. 1994;34(2):99–102.
Udoji MA, Ness TJ. New directions in the treatment of pelvic pain. Pain Manag. 2013;3(5):387–94.
Hall E, Hall C, Stradling P, Young D. Guided imagery: creative interventions in counselling & psychotherapy. London: SAGE; 2006. 143 p.
Brewin CR, Wheatley J, Patel T, Fearon P, Hackmann A, Wells A, et al. Imagery rescripting as a brief stand-alone treatment for depressed patients with intrusive memories. Behav Res Ther. 2009;47(7):569–76.
Smucker MR, Dancu C, Foa EB, Niederee JL. Imagery rescripting: a new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. J Cogn Psychother. 1995;9(1):3–17.
Rusch MD, Grunert BK, Mendelsohn RA, Smucker MR. Imagery rescripting for recurrent, distressing images. Cogn Behav Pract. 2000;7(2):173–82.
Barber J, Hilgard ER. Hypnosis and suggestion in the treatment of pain: a clinical guide. New York: W.W. Norton; 1996. 439 p.
Philips C, Samson D. The rescripting of pain images. Behav Cogn Psychother. 2012;40(5):558–76.
Lewandowski WA. Patterning of pain and power with guided imagery. Nurs Sci Q. 2004;17(3):233–41.
Lewandowski W, Good M, Draucker CB. Changes in the meaning of pain with the use of guided imagery. Pain Manag Nurs. 2005;6(2):58–67.
Lewandowski W, Jacobson A, Palmieri PA, Alexander T, Zeller R. Biological mechanisms related to the effectiveness of guided imagery for chronic pain. Biol Res Nurs. 2011;13(4):364–75.
Arntz A. Imagery rescripting as a therapeutic technique: review of clinical trials, basic studies, and research agenda. J Exp Psychopathol. 2012;3(2):189–208.
Winterowd C, Beck AT, Gruener D. Cognitive therapy with chronic pain patients. New York: Springer; 2003. 392 p.
Leahy RL. Science and practice in cognitive therapy: foundations, mechanisms, and applications. New York: Guilford Publications; 2018. 418 p.
Dance AD. Guided imagery as a coping mechanism for endometriosis: a mixed-methods approach. Doctor of philosophy in integrative medicine and health sciences [Thesis] [cited 13/01/2019]. Oakland, California: Saybrook University; 2017. Available from https://search.proquest.com/openview/bf4c4b8056c00422703de97632d48f9e/
Singer JL. Imagery in psychotherapy. Washington, DC: American Psychological Association; 2006. 225 p.
Stopa L. Imagery and the threatened self: perspectives on mental imagery and the self in cognitive therapy. New York: Routledge; 2009. 282 p.
Hayes SC, Strosahl KD. A practical guide to acceptance and commitment therapy. New York: Springer US; 2004. 396 p.
Cederberg JT, Cernvall M, Dahl J, von Essen L, Ljungman G. Acceptance as a mediator for change in acceptance and commitment therapy for persons with chronic pain? Int J Behav Med. 2016;23(1):21–9.
Gillanders DT, Ferreira NB, Bose S, Esrich T. The relationship between acceptance, catastrophizing and illness representations in chronic pain. Eur J Pain. 2013;17(6):893–902.
Vowles KE, Thompson M. Acceptance and commitment therapy for chronic pain. In: McCracken L, editor. Mindfulness and acceptance in behavioral medicine: current theory and practice. Oakland, CA: New Harbinger Publications; 2011. p. 31–60.
Dahl J, Luciano C, Wilson K. Acceptance and commitment therapy for chronic pain. Reno, NV: New Harbinger Publications; 2010. 224 p.
D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003;21(2):243–54.
Purdie F, Morley S. Compassion and chronic pain. Pain. 2016;157(12):2625–7.
Smith JA, Osborn M. Pain as an assault on the self: an interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychol Health. 2007;22(5):517–34.
Gilbert P. Compassion focused therapy: distinctive features. New York: Routledge; 2010. 248 p.
Rockliff H, Gilbert P, McEwan K, Lightman S, Glover D. A pilot exploration of heart rate variability and salivary cortisol responses to compassion-focused imagery. Clin Neuropsychiatry J Treat Eval. 2008;5(3):132–9.
Kennerley H. Cognitive therapy of dissociative symptoms associated with trauma. Br J Clin Psychol. 1996;35(3):325–40.
Acknowledgments
The authors are grateful to Dr. Simon van Rysewyk for his edits of this chapter; Dr. David Gillanders for offering comment on questionnaire design; Dr. Katy Vincent for expert review of our international research; the creators and distributors of the validated and reliable measures: Short-Form McGill Pain Questionnaire 2 ([39] access from Mapi Research Trust: https://eprovide.mapi-trust.org, adapted with permission), Pain Catastrophizing Scale ([40] now access is also from Mapi Research Trust: https://eprovide.mapi-trust.org), and Depression, Anxiety and Positive Outlook Scale [41]; all of the endometriosis patient organisations (Endometriosis UK, Endometriosis Foundation of America, Endometriosis.org, Endometriosis New Zealand, Endometriosis Australia, and The Endometriosis Network Canada) for advertising the online survey; and all of the participants who completed the questionnaire. The international pain imagery research was supported by an MRC Centre Grant (MR/N022556/1).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Graham, C.J., Brown, S.L., Horne, A.W. (2019). The Importance of Pain Imagery in Women with Endometriosis-Associated Pain, and Wider Implications for Patients with Chronic Pain. In: van Rysewyk, S. (eds) Meanings of Pain. Springer, Cham. https://doi.org/10.1007/978-3-030-24154-4_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-24154-4_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-24153-7
Online ISBN: 978-3-030-24154-4
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)