Explicit Motor Imagery Deficits in Individuals With Chronic Pain: A Systematic Review and Meta-Analysis

Chronic pain has been associated with disrupted sensorimotor integration and altered internal body representations. While implicit motor imagery (MI) has been explored in pain populations, explicit MI, defined as the deliberate mental simulation of movement, remains less well understood.

This systematic review and meta-analysis aimed to examine differences in explicit MI ability, vividness, and mental chronometry between individuals with chronic pain and healthy controls.

We screened six databases for observational studies comparing explicit MI outcomes in chronic pain or clinically relevant persistent/recurrent pain-related conditions versus asymptomatic healthy populations. Random-effects and multilevel meta-analyses were conducted using standardized mean differences (SMD) and 95% confidence and prediction intervals. Methodological quality was assessed with the JBI and NOS tools.

Twelve studies (n = 1603) met inclusion criteria. Individuals with pain-related clinical conditions showed moderate-to-large deficits in MI ability (SMD = -0.96), vividness (SMD = 1.06 for kinesthetic vividness), and mental chronometry (SMD = 0.84), although heterogeneity varied across outcomes. Mental chronometry showed the most consistent pattern across studies, whereas imagery ability and vividness were associated with greater between-study variability. Correlational analyses identified perceived disability, self-efficacy, and kinesiophobia as relevant moderators.

Individuals with chronic pain appear to display significant impairments in explicit MI, particularly in temporal simulation and some kinesthetic dimensions. However, these findings should be interpreted in light of the clinical and methodological heterogeneity across included studies.