When neurosurgeon and journalist Dr. Sanjay Gupta set out to write a book about pain, it wasn't because he felt like he had all the answers. It was because he was still so often mystified by it.
"Most of my patients come to me for pain. Head pain, back pain, neck pain, whatever it might be," he says. "If that's what the majority of your professional life is, you should understand it as best you can."
His 2025 book, It Doesn't Have to Hurt: Your Smart Guide to a Pain-Free Life, gathers the latest developments in pain science, based on his own experience with patients and conversations with researchers and doctors.
What he found may challenge your own understanding of pain and even give you the tools to help you feel better. There's evidence, for example, that just learning about pain and how it works "seems to be pain relieving" for those with chronic pain conditions, he says.
Gupta, who also serves as the chief medical correspondent for CNN, explains what we still don't know about pain and shares a few effective new treatments. This interview has been edited for length and clarity.
In your book, you say that one of the most significant developments emerging in pain treatment is the fact that the brain is at the center of any pain experience. Can you tell us more about why that matters?
What I think has become clear — and I'm not the first person to say this — is the idea that if the brain doesn't decide you have pain, then you don't have pain.
The brain can also create pain where it seems like it wouldn't exist. One of the best examples of that is phantom limb pain, which for a long time baffled people. Pain is a mysterious thing. Some people respond very differently, and even the same person may respond differently at different times.
You give an example of this in your book.
The story of the two Joannas. It just so happened that I operated on two women on the same day, who basically had the same problem and were similar in terms of age and medical history.
You can always tell when you walk into a patient's room how they're doing. I walked into Joanna No. 1's room the day [after the operation], and she'd already put on lipstick. Her hair was combed. She was discharged shortly thereafter. But Joanna No. 2 was just miserable.
If I had done Joanna No. 2's operation a week later, maybe she would've had a totally different outcome, and that would've been because she was less stressed, better fed, the weather was nicer outside. The things you don't think matter can matter a whole lot when it comes to pain.
This can happen with chronic pain, right? In some cases, doctors can't find an underlying cause or injury. Or maybe there used to be an injury, but someone still has severe or consistent pain.
Correct. Chronic pain is pain that occurs for at least three months. But there are people who have pain for decades. Why this happens is still a mostly unanswered question. There's nothing off-limits in terms of [what could be] possibly contributing to pain, especially when that pain becomes chronic.
You say that mindfulness therapy, like meditation and breathing exercises, can be an effective treatment in managing pain. Can you share one method and how it works?
There's one protocol in particular called MORE: Mindfulness-Oriented Recovery Enhancement. For a significant percentage of people who have chronic pain without an underlying anatomical problem, it can be really effective.
[Practitioners] say: Hey, don't just lean into the pain, but think of a pleasant scene. This is the idea that the toxicity of pain can be somehow remedied by thinking about something far more pleasant, whatever it might be — flowers, a sunset, time with your kids.
The idea that MORE could bring pain scores down for a period of time is proof of just how much of this is occurring in the brain and how much of it is within our control.
One of the surprising new developments in pain is how we deal with injuries — say, an ankle sprain. For a long time, we've been told to follow the RICE acronym to reduce inflammation and heal the injury. But new research suggests otherwise.
The RICE acronym — rest, ice, compress, elevate — all these things fundamentally decrease inflammation.
But there was a paper that came out a few years ago that upended the thinking on this. Researchers were trying to answer the question: Who is more likely to have chronic pain? What demographic of people, with what medical history?
What they found is that the people who had the highest levels of inflammation at the time of the injury were the least likely to have chronic pain.
Now what you're hearing from pain doctors is to lean into the pain.
The new acronym to follow is MEAT: movement, exercise, analgesia and treatment.
Mobilize the joint, exercise, use pain medication if necessary, but don't use anti-inflammatories.
You're less likely to have chronic pain if you do that early mobilization and don't focus as much on decreasing inflammation.
It's helpful to know there are lots of different things to try. You just have to get plugged into the right information.
When you're dealing with something as mysterious as pain, you should have a big menu of options to choose from. And while nothing works for everybody, there's probably something that works for anybody.
Listen to the podcast episode for more pain treatments and therapies from Dr. Sanjay Gupta.
This story was edited by Malaka Gharib. We'd love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org.
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