Pain catastrophizing is associated with altered EEG effective connectivity during pain‑related mental imagery

Pain catastrophizing - defined as a tendency to exaggerate the threat value or seriousness of experienced pain ‑ has been shown to be a risk factor for pain chronification. However, the neural basis of pain catastrophizing remains unclear and requires thorough investigation. This study aimed to explore the relationship between pain catastrophizing and effective connectivity of the pain systems in healthy participants. EEG data were collected during an induced state of pain‑related negative, depressive, positive and neutral mental imagery conditions, and pain catastrophizing tendencies were measured by the Pain Catastrophizing Scale. The Directed Transfer Function, a method based on Granger causality principles, was used to assess the effective connectivity. Linear mixed effects analyses revealed a negative relationship between pain catastrophizing and beta information flow from the right temporal cortex to the frontal regions and a positive relationship between pain catastrophizing and increased beta information flow from the right somatosensory cortices to the right temporal cortices when thinking about pain. These patterns were not found in other imagery conditions. Taken together, this study suggests that individual differences in pain catastrophizing might be related to an altered frontotemporal regulatory loop and increased connectivity between pain and affective systems. Our study reveals connectivity patterns related to pain catastrophizing tendencies that are detectable even in pain‑free, healthy individuals.