Interventional pain physicians frequently encounter patients with a treatment refractory "chronic pain syndrome." Such patients have chronically painful medical disorders that are complicated by a number of psychosocial factors, including premorbid or comorbid psychiatric and substance use disorders, physical deconditioning, dependency upon the healthcare system, and perceived impairments that are out of proportion to objective medical findings. A growing body of empirical evidence indicates that the effectiveness of medical interventions is diminished for patients with such psychosocial complications (1-3). There is