Dr. Sanjay Gupta explains what we do — and still don’t — know about pain : NPR

When neurosurgeon and journalist Dr. Sanjay Gupta decided to write a book about pain, it wasn’t because he felt like he had all the answers. It was because he was still intrigued by it so often.

“Most of my patients come to me for pain. Headaches, back pain, neck pain, whatever,” he says. “If this is the majority of your working life, you need to understand it as best you can.”

His book 2025, It Doesn’t Have to Hurt: Your Smart Guide to Pain-Free Livingbrings together the latest developments in pain science, based on his own experience with patients and conversations with researchers and doctors.

What he discovered could challenge your own understanding of pain and even give you the tools to help you feel better. There is evidence, for example, that learning on pain and how it works “seems to provide pain relief” for people with chronic pain, he says.

Gupta, who is also CNN’s chief medical correspondent, explains what we still don’t know about pain and shares some effective new treatments. This interview has been edited for length and clarity.

In your book, you say that one of the most significant developments in pain treatment is the fact that the brain is at the center of every painful experience. Can you tell us more about why this is important?

What I think has become clear — and I’m not the first to say this — is the idea that if the brain doesn’t decide that you have pain, then you have no pain.

The brain can Also creating pain where it seems not to exist. One of the best examples of this is phantom limb pain, which has long confused people. Pain is a mysterious thing. Some people react very differently, and even the same person can react differently at different times.

You give an example of this in your book.

The story of the two Joannas. I happened to operate on two women on the same day who had basically the same problem and were similar in age and medical history.

When you walk into a patient’s room, you can always tell how they are doing. I walked into Joanna’s room #1 that day [after the operation]and she had already put on lipstick. Her hair was combed. She was released shortly after. But Joanna #2 was just unhappy.

If I had operated on Joanna #2 a week later, maybe she would have had a totally different result, and it would have been because she was less stressed, better fed, the weather was nicer outside. Things you don’t think are important can mean a lot when it comes to pain.

This can happen with chronic pain, right? In some cases, doctors are unable to find a cause or underlying injury. Or maybe there was an injury, but someone still feels intense or constant pain.

Correct. Chronic pain is pain that lasts at least three months. But there are people who have suffered for decades. Why this happens is still an unanswered question. There is nothing prohibited in terms of [what could be] can contribute to pain, especially when this pain becomes chronic.

You say that mindfulness therapy, such as meditation and breathing exercises, can be an effective treatment for managing pain. Can you share a method and how it works?

There is a particular protocol called MORE: Mindfulness-Oriented Recovery Enhancement. For a significant percentage of people with chronic pain without an underlying anatomical problem, this can be very effective.

[Practitioners] say: Hey, don’t just focus on the pain, but think about a pleasant scene. It’s the idea that you can somehow remedy the toxicity of pain by thinking of something much nicer, whatever it may be: flowers, a sunset, time with your children.

The idea that MORE could reduce pain scores for a period of time is evidence of how much of this happens in the brain and how much of this is within our control.

One of the surprising new developments in pain is how we treat injuries, such as a sprained ankle. For a long time, we were told to follow the acronym RICE to reduce inflammation and heal the injury. But new research suggests otherwise.

The acronym RICE – rest, ice, compression, elevation – all of these things basically decrease inflammation.

But an article published a few years ago shook up thinking on this subject. The researchers were trying to answer the following question: who is most likely to suffer from chronic pain? What demographic, with what medical history?

What they found was that people who had the highest levels of inflammation at the time of injury were most affected. less likely to suffer from chronic pain.

Now what the pain doctors tell you is to lean into the pain.

The new acronym to follow is MEAT: Movement, Exercise, Analgesia and Treatment.

Mobilize the joint, exercise, use painkillers if necessary, but do not use anti-inflammatories.

You’re less likely to have chronic pain if you do this early mobilization and don’t focus as much on decreasing inflammation.

It helps to know that there are many different things to try. You just need to connect to the right information.

When you’re dealing with something as mysterious as pain, you should have a wide menu of options to choose from. And even if nothing works for everyone, there is probably something that works for everyone.

Listen to the podcast episode for more pain treatments and therapies from Dr. Sanjay Gupta.

This story was edited by Malaka Gharib. We would love to hear from you. Leave us a voicemail at 202-216-9823 or email us at LifeKit@npr.org.

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