Investigating Pain Modulation Through Visual Imagery and Injury Perception Post-Mild Traumatic Brain Injury: An ERP Study

Abstract

Traumatic brain injury (TBI) is a significant health concern in the United States, with mild traumatic brain injuries (mTBI) occurring most frequently among adolescents and young adults. Although mTBI is often considered less severe, individuals may continue to experience persistent symptoms, including pain and psychological distress. Emerging research suggests that cognitive factors, like injury perceptions, may influence how these symptoms are experienced and processed. However, limited research has examined how these perceptions relate to the neural processing of pain using neurophysiological methods. The present study investigated whether perceived control over injury-related symptoms was associated with neural responses to pain-related imagery and whether injury status moderated this relationship. Participants (N = 54) completed self-report measures of depressive symptoms, pain catastrophizing, and injury perceptions, followed by a visual imagery task during which EEG was recorded. Event-related potentials (ERP), specifically P2 and P300, were analyzed in a subset of participants with usable EEG data (N = 21). Results showed no significant group differences in P2 and P300 amplitudes. Perceived control was not associated with ERP responses or moderated by injury status. Exploratory analyses revealed significant group differences in self-report measures, with control participantsreporting greater psychological distress and emotional representations, and the mTBI group reporting higher illness coherence. These findings suggest that self-reported cognitive-emotional factors may not directly map onto neural responses to pain-related imagery, emphasizing the need for multimodal approaches in mTBI research.