Background: Chronic pain patients often describe their pain in ways that suggest vivid mental images, with some reporting images relating to their pain. Despite these clinical observations, there are few studies describing the nature and consequences of these images. This study examined whether mental imagery of pain is associated with levels of reported distress, cognitions, disability or pain severity. Method: In a postal survey, 83 adult chronic pain patients indicated whether or not they experienced mental images of their pain. They also completed standardized measures of depression, anxiety, cognitions, disability and pain severity. Those reporting images were compared to those not reporting images on their responses to the other variables. Results: People with pain imagery reported significantly higher levels of anxiety, depression and catastrophizing than patients who did not report such images. No differences were found on measures of physical disability. Discussion: Mental images of pain appear to be associated with higher levels of anxiety, depression and catastrophizing. It is possible that these images play a role in maintaining such difficulties. For these patients, imagery may provide a route via which clinicians can work with patients to help them reinterpret or respond more flexibly to their pain.