By Dr. Stephen F. Grinstead, LMFT, ACRPS 

If you have any topics you would like me to cover in future Articles, please 

email me at or call me at (916) 893-3155.


Defining Effective Chronic Pain Management


Given the biopsychosocial nature of chronic pain conditions it is imperative to utilize a multidisciplinary treatment plan for effective pain management. Living with chronic pain is very difficult. If you also have a coexisting addiction or other psychological conditions, it becomes even more challenging. People with chronic pain and coexisting disorders can become severely depressed and feel hopeless. Their self-esteem is practically non-existent and many of them lose the support of their significant others. 

Healthcare providers often become confused and frustrated when their treatment interventions are ineffective. Also, people living with chronic pain must educate themselves and be proactive consumers regarding health practitioners who claim to do pain management. Be wary, if they offer only one type of modality for addressing your pain, such as medication management, or chiropractic adjustments or acupuncture.

True multidisciplinary pain management involves interventions such as physical therapy, massage, medication management, counseling or therapy, biofeedback, occupational therapy, exercise physiology, an anesthesiologist or pharmacologist, and a case manager all at one site, at a minimum. It may also involve some type of movement therapy such as Tai Chi, classes on spiritual wellness, yoga or meditation.

Success Requires A Team Approach

In my experience, a multidisciplinary team is crucial in order to address the specific biopsychosocial needs of people living with chronic pain. In addition, the physical, psychological, and social implications of chronic pain and any coexisting condition—including the impact on family systems—must also be adequately dealt with.

Using a multidisciplinary team is crucial when treating the synergistic problems people and their families’ face that have been severely impacted by chronic pain, especially when addiction and other psychological problems are present. When these conditions coexist it creates a major challenge that must be addressed through a collaborative treatment approach. The inclusion of addiction, mental health and medical is vital to this process. 

When these coexisting conditions occur, the family problems increase synergistically. Effective treatment can be challenging and confusing for counselors, therapists and other healthcare providers, but especially for patients and their families. I have found that the strategic three-part approach mentioned in last month’s article improves treatment outcomes and gives people living with chronic pain and their families new hope.

 To  request  the remainder of this article, please connect with me at


Exploring The Stress Pain Connection


You Can’t Effectively Manage Your Pain  Without Managing Your Stress  

It is important to understand the connection between stress levels and pain symptoms, as well as how managing stress can decrease the perception of pain. Physically, chronic pain raises stress levels and drains physical energy, while psychologically it impacts the ability to think clearly, logically and rationally, as well as how effectively patients manage their feelings. Not only that, it can impact memory.  In most cases when someone learns how to lower their stress levels, they will also experience a decrease in their perception of pain. 


Of course, before patients can manage stress, they first need to learn how to describe their level of stress at any given time. It’s important to remember that when someone reaches the upper moderate to severe levels of stress (6-10 range or what I call the “stress reaction”) thinking, emotions and behaviors are affected. The goal is to keep the level of stress at six or below as much as possible. 

Since self-assessing levels of stress and learning how to implement simple but effective stress management tools is so important, we need an instrument, or tool, to help do that. I use the Gorski-CENAPS®Stress Thermometer below as a starting point to help patients accurately articulate their level of stress. In the next section I will take you through this exercise in the same way I do with patients.

To request the remainder of this article, please connect with me at


Relapse Prevention Planning for Chronic Pain Management

Understanding What Relapse Really Is 

If you ask someone in the medical field about relapse, they most likely will say relapse is going back to an active state of a disease after a period of remission. When you ask someone recovering from inappropriate use of medications, including using alcohol or other drugs they may say it’s going back to using the substance again. 

While that definition is partially correct, it can be dangerous, especially if people thinks the only criteria for recovery is abstinence. Another common definition of relapse is that a person goes back to their addiction process. The full explanation of relapse is much more complex and must include not only maintaining abstinence or an appropriate medication management plan but also stop following their mental health treatment plan or sabotaging their chronic pain management plan. 

  • People can head back towards chemical use 
  • Start sabotaging their chronic pain plan
  • Stop following their mental health treatment plan

What many people don’t realize is that the chemical use or coming out of remission is not the beginning of a relapse. It is the final step in an ongoing relapse process. In addition, relapse is a common symptom of a medication use disorder or other chemical use disorders, and one-third to two-thirds of all recovering people in chemical recovery relapse despite their best intentions not to do so. 

If someone is also living with a coexisting disorder—e.g., chronic pain, depression, PTSD or an anxiety disorder—the instance of relapse can be even higher because these other problems can easily become a relapse justification. Fortunately, the risk of relapse can be lowered if recovering people are exposed to education and training about relapse prevention and how to deal more effectively with all of their coexisting problems. Prevention is much easier than crisis management. 

To  request  the remainder of this article, please connect with me at

Free: Prologue, Table of Contents, Forward & First Chapter

For Archived Articles Go To The "Pain Article Archive" Link Below