Abstract: The bidirectional relationship between temporal cognition and pain has attracted increasing attention due to its theoretical and practical implications. While existing studies have explored these interactions, their findings remain fragmented and lack a coherent theoretical framework. This study systematically integrates empirical research conducted between 1984 and 2024 to elucidate the underlying mechanisms of the bidirectional interactions between temporal cognition and pain. Additionally, it identifies critical future directions to address unresolved issues in the field, thereby contributing to the development of more effective approaches for pain management and temporal cognition interventions. This study highlights three key innovations. Firstly, it identifies the bidirectional nature of the relationship between temporal cognition and pain. On the one hand, pain influences temporal cognition, leading to outcomes such as lengthening, shortening, or having no significant effect on perceived durations. On the other hand, temporal cognition affects pain perception, whereby temporal cues and perceived durations can increase, decrease, or have no impact on pain intensity, tolerance, and sensitivity. Secondly, the study explains these findings within three established theoretical frameworks: the Attentional Gate Theory, Gate Control Theory, and Neuromatrix Theory, offering a multifaceted understanding of these phenomena. To be specific, regarding the influence of pain on temporal cognition, the findings are linked to higher arousal or attentional resource allocation to time, attentional focus on pain, or normalized arousal with disrupted temporal and normal processing or reduced cognitive variability. These mechanisms emphasize the role of attentional shifts and arousal levels in shaping the perception of time during painful experiences. Regarding the influence of temporal cognition on pain perception, the impact on pain intensity is associated with the inhibition of neurotransmitter release, negative emotions or emotional stability; increased and decreased pain tolerance are linked to attentional focus on time and negative emotions, respectively; increased and decreased pain sensitivity are associated with negative emotions and the inhibition of neurotransmitter release, respectively. These findings not only highlight the role of emotion and attention but also underscore the importance of physiological mechanisms. Finally, this study outlines three key future research priorities that aim to advance the field: it emphasizes the need to focus on the dynamic relationship between chronic pain intensity (the vector of arousal and valence) and temporal cognition, as well as its moderating factors and investigate the mediating mechanisms of attention and arousal in the influence of pain on deviations in temporal cognition, along with their boundary conditions; it also calls for further exploration of the mediating mechanisms of attention and arousal in the effects of temporal cues and durations on pain tolerance or sensitivity, as well as their boundary conditions; what’s more, it advocates for the development and evaluation of the manipulation mechanisms of pain and temporal interventions, with a focus on practical applications in clinical settings, such as, the timing management of medication administration. This study holds significant theoretical and practical implications. It not only provides a solid theoretical foundation for understanding the bidirectional relationship between temporal cognition and pain but also offers a more integrated perspective compared to previous fragmented findings. Furthermore, it sheds light on the complex roles of attention and arousal, delivering valuable insights for developing strategies to manage and intervene in pain effectively. In summary, this study systematically integrates empirical research based on diverse findings and interprets them within theoretical models of pain and temporal cognition. It explores the mechanisms involving attention, arousal, emotion, and physiological processes, highlighting the mediating roles of attention and arousal. These insights lay a solid foundation for future research aimed at uncovering these mediating mechanisms and developing effective interventions targeting both pain and temporal cognition. By advancing theoretical understanding and practical applications, this study contributes to a growing body of knowledge that holds the potential to improve pain management and enhance temporal cognition interventions.

Key words: pain, interval timing, attention and arousal, Attentional Gate Theory, Gate Control Theory, Neturomatrix Theory