A good movie can captivate us so much that we almost forget hunger, cold, or time. Our brain shifts priorities in favor of the story. A similar effect can be purposefully utilized for chronic pain: The "direction" of inner images can dampen pain signals, redirect attention, and rewrite one’s own pain perception.

Chronic pain is not merely a question of tissue but rather a product of nerve impulses, interpretation, and emotion. The processing in the brain is crucial. Guided imagery mental imageryintentional creation of vivid inner images and sensory impressions employs this exactly: It activates networks that typically process real experiences, thus influencing perception and behavior. Cognitive Behavioral Therapy CBTa psychological approach that deliberately changes thoughts, feelings, and actions strengthens "top-down" control – that is, the ability of the prefrontal cortex to modulate pain information. And Motor Imagerymentally going through movements without actual execution connects the brain and the movement system to decouple painful patterns. For high performers, this perspective is essential: Those who redraw the mental map not only change pain but also energy, focus, and performance.

Studies show that guided imagery exercises can reduce pain intensity while simultaneously improving cognitive functions. In a study on knee osteoarthritis, pure mental imagery reduced pain more than conventional physiotherapy – and additionally improved visual processing, suggesting more efficient top-down mechanisms ^[1]. In another study, individuals with chronic pain reported less pain as well as improved mood and functioning after home use of virtual reality (VR) or auditory imagery – indicating that regular practice has cumulative effects and is practical for daily life ^[2]. Additionally, simply observing and/or imagining movement can raise the pain threshold, thereby triggering acute hypoalgesia – a fascinating lever to reduce movement-related anxiety and rebuild activity ^[3].

A randomized study with patients suffering from knee osteoarthritis compared ten days of conventional physiotherapy with pure mental imagery of the same applications. Both groups benefited, but imagery reduced pain intensity more and accelerated reaction times in a visual recognition task, suggesting improved cognitive processing and enhanced top-down modulation ^[1]. In another randomized feasibility study on guided imagery at home – either via virtual reality or audio – participants rated the intervention as manageable and acceptable; within the groups, pain, anxiety, and depressive symptoms decreased while physical and mental function improved. This supports the practical integration into daily life and highlights digital formats as adherence boosters ^[2]. Additionally, a controlled pilot study with healthy adults provided a mechanistic component: Merely observing or imagining previously completed endurance and isometric exercises increased pressure pain threshold – in some cases after just minutes. This indicates that brain training via motor and attention-sensitive networks allows for acute pain modulation and can potentially be integrated into rehabilitation plans ^[3]. Finally, neuroimaging-based reviews of CBT illustrate that after interventions, regions involved in cognitive and emotional regulation are more consistently engaged – including DLPFC, OFC, VLPFC, PCC, and the amygdala. The pattern suggests stronger top-down control, cognitive reevaluation, and altered processing of recurring pain impulses ^[4]. Concurrently, a recent systematic review found that CBT – whether in-person or digital, sometimes as ACT – reduces pain-related disability in the majority of studies, particularly benefiting those with chronic back pain, generalized pain, migraines with depression, and long-term opioid use ^[5].

- Start with guided imagery: Choose 10–15 minutes daily, put on headphones, and follow an imagery guide (audio or VR). Aim to create a safe, calming place where your body feels weightless and warm. Document your pain intensity (0–10) before and after the session to make progress visible ^{[2] [1]}.
- Build a personal mental travel plan: Write down three scenes in which you experience yourself pain-free and competent (e.g., a beach run at dawn, a meeting with absolute clarity, a mountain hike with stable knees). Fill each scene with sensory details – temperature, light, sounds, scent. Repeat these sequences daily; particularly use a "protection image" variant, for example, a warming glove over the pain area, which studies have shown can reduce pain perception ^[6].
- Connect movement with imagination: Imagine carrying out a short, realistic training sequence smoothly and painlessly (e.g., 3×30 seconds of brisk walking, isometric squats). Observe the movement internally in real-time and supplement it – if possible – with very light, real execution. This brain priming can increase the pain threshold and reduce fear of movement ^[3]. For osteoarthritis: Complement physiotherapy with mental imagery of the same applications when an appointment is missed – this can maintain the analgesic effect ^[1].
- Integrate CBT micro-tools into daily life: Use "Thinking → Feeling → Acting" as a quick check. When pain flares up, identify the automatic thought ("It will get worse if I move"). Replace it with an evidence-based alternative ("Movement in small doses helps my system respond more calmly"). Then plan a concrete mini-action (2 minutes of walking, 3 breaths plus shoulder relaxation). These skills are core components of effective CBT programs that reduce disability and strengthen top-down control ^{[5] [4] [7]}.
- Establish a weekly ritual for continuity: Three components, 5 days a week: 10 minutes of guided imagery (audio/VR), 10–20 minutes of light activity with a mental warm-up, 2 minutes of CBT reflection in a journal (trigger, thought, alternative, action). Consistency is the amplifier of the cumulative effects observed in studies ^{[2] [3]}.

Mental journeys are not escapism but a precise tool: They sharpen the top-down regulation of the brain and make chronic pain more pliable. Those who cleverly combine imagery, movement, and CBT regain control – and thus energy for health, performance, and joy in life.