Pain Medicine 2011; 12: 1086–1093 Wiley Periodicals, Inc. PSYCHOLOGY, PSYCHIATRY & BRAIN NEUROSCIENCE SECTION Original Research Article Presence of Mental Imagery Associated with Chronic Pelvic Pain: A Pilot Study pme_1521086.1093 Patients. Ten women with chronic pelvic pain con- secutively referred from a tertiary referral center by the physicians in charge of their treatment. Hitherto, most assessments of negative pain-related cognitions have focused on verbal thought processes (e.g., [2,3]). In contrast, spontaneous negative cognitions Chantal Berna, PhD,*† Katy Vincent, PhD,†‡ Jane Moore, MSc,‡ Irene Tracey, PhD,† Guy M. Goodwin, PhD,* and Emily A. Holmes, PhD* *Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford; †Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Department of Clinical Neurology & Nuffield Department of Anaesthetics, University of Oxford, Oxford; ‡Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, UK Reprint requests to: Chantal Berna, PhD, EPACT Group, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. Tel: +44-1865-226-487; Fax: +44-1865-223-948; E-mail: cberna@fmrib.ox.ac.uk. CB is supported by a Lord Florey Scholarship of the Berrow Foundation and an Eugenio Litta Scholarship, KV is funded by an NIHR Academic Clinical Lecturer Award, and EH is supported by a Wellcome Trust Clinical Fellowship (WT088217) and a grant from the Lupina Foundation. Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen# OnlineOpen_Terms Objective. To ascertain whether a small sample of patients with chronic pelvic pain experienced any pain-related cognitions in the form of mental images. Abstract 1086 Outcome measures. An interview was used to determine the presence, emotional valence, content, and impact of cognitions about pain in the form of mental images and verbal thoughts. The Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Spontaneous Use of Imagery Scale (SUIS), and Hos- pital Anxiety and Depression Scale (HADS) were completed. Results. In a population of patients with a pro- longed duration of pain and high distress, all patients reported experiencing cognitions about pain in the form of mental images. For each patient, the most signiﬁcant image was both negative in valence and intrusive. The associated emotional- behavioral pattern could be described within a cog- nitive behavioral therapy framework. Eight patients also reported coping imagery. Conclusion. Negative pain-related cognitions in the form of intrusive mental imagery were reported by women with chronic pelvic pain. Targeting such imagery has led to interesting treatment innovation in the emotional disorders. Thus, imagery, hitherto neglected in pain phenomenology, could provide a novel target for cognitive behavioral therapy in chronic pain. These exciting yet preliminary results require replication and extension in a broader popu- lation of patients with chronic pain. Key Words. Mental Imagery; Chronic Pain; Pelvic Pain; Cognition; Cognitive Behavioral Therapy Introduction Pain suffering can be maintained or enhanced by negative cognitions. Therefore, exploring patients’ cognitions about their pain is not only important for our understanding of their experience, but also to identify potentially unhelpful thoughts involved in symptom maintenance [1]. These could then be addressed through cognitive behavioral therapy (CBT).