Pod Insights Life Kit Plus Dr. Sanjay Gupta wants you to reframe your understanding of pain About this episode Why do we have pain in the absence of injury, or long after our tissue has healed? How can the same pain stimulus feel so different, depending on who you are, or even what day it is? Neurosurgeon and CNN chief medical correspondent Dr. Sanjay Gupta, author of It Doesn't Have to Hurt: Your Smart Guide to a Pain-Free Life, talks about some of the surprising developments in pain science, including non-opioid treatments you may not know about.
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Transcript Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
0:00 Speaker 00 This message comes from Charles Schwab with their original podcast, Choiceology. Choiceology is a show about the psychology and economics behind people's decisions. Download the latest episode and subscribe at schwab.com/podcast.
0:15 Marielle Segarra? You're listening to Life Kit from NPR.
0:20 Marielle Segarra? Hey, it's Marielle. I want to talk about RICE. Not the grain, the acronym we're given to help us remember what to do after an injury. R, rest. I, ice. C, compression. And E, elevation. The idea is that you want to let your body recover while minimizing inflammation. Turns out, pain doctors have a new acronym now, featuring very different advice.
0:45 Speaker 02 They would say MEAT.
0:47 Marielle Segarra? That's M, movement, E, exercise, A, analgesia, and T, treatment, like physical therapy and massage. That, by the way, was Dr. Sanjay Gupta. Maybe you've heard of him? He's a neurosurgeon and a medical reporter for CNN. He says the thinking has changed on this because we've learned that actually inflammation after an injury can be a good thing.
1:08 Speaker 02 It's really interesting, you know, to tell people who are injured to get up and walk on it or do whatever, because that's not what they're used to hearing. But it's almost like if you allow the body to do its job, if you allow those inflammatory molecules to rush to the scene and do their job, they do a pretty good job. And you're less likely to have chronic pain if you do that early mobilization and don't focus as much on decreasing inflammation.
1:35 Marielle Segarra? Sanjay has been reporting on pain science for a while now, and he wrote a book called It Doesn't Have to Hurt: Your Smart Guide to a Pain-Free Life. It's estimated that about 20% of people in the US are currently dealing with chronic pain.
1:49 Speaker 02 We hurt. Our world hurts.
1:52 Marielle Segarra? At the same time, there are researchers studying this topic, and what they've learned might challenge your understandings of pain, where it comes from, and how we can feel better. That was the case for me. Also, researchers have found that simply learning about pain science can help with chronic pain conditions. So on this episode of Life Kit, I talked to Sanjay about some of the surprising developments in pain science, including non-opioid treatments you may not know about. We'll also get into what pain and chronic pain are and why you might have them even when doctors can't find an obvious source. That's after the break.
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3:41 Speaker 03 This message comes from Charles Schwab with their original podcast, Choiceology. Hosted by Katie Milkman, an award-winning behavioral scientist and author of the bestselling book, How to Change. Choiceology is a show about the psychology and economics behind people's decisions. Hear true stories from Nobel laureates, historians, authors, athletes, and more about how to make better decisions to help avoid costly mistakes. Download the latest episode and subscribe at schwab.com slash podcast or wherever you listen.
4:12 Marielle Segarra? You say in the book that one of the most significant and surprising 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?
4:24 Speaker 02 What I think has become clear, and I'm not the first person to say this, the idea that if the brain doesn't decide you have pain, then you don't have pain. And the brain can also create pain where it seems like it wouldn't exist. And I think one of the best examples of that is phantom limb pain, which for a long time, you know, has baffled people, like the limb doesn't even exist anymore. These have been long, you know, sort of regarded as mysteries, but I think what we've concluded is that the brain will decide, hey, that actually doesn't hurt, or that does hurt. And it may seem completely out of sorts with what you think the experience should be.
5:04 Marielle Segarra? And you talk about this in the book. You can see that too in two people having a very similar set of circumstances and maybe the same surgery. I think this happened when you performed surgery on two people, and then one is in debilitating pain the day after, and the other one is sitting up and talking and everything's fine.
5:21 Speaker 02 The story of the two Joannas, it just so happened that I ended up operating on two women on the same day that basically had the same problem and were very, very similar, not only in terms of what the medical issue was, but in terms of they themselves, around the same age, same, you know, medical history and everything. And I walk into Joanna number one's room the next day, and you can always tell, right when you walk into a patient's room, how they're doing, even before you examine them, you know, the window shades are open, she'd already put on lipstick, her hair was combed. And she was discharged shortly thereafter. Joanna number two, same operation, same medical history, and she was just miserable. And first thing you think is like, did I miss something here?
6:05 Speaker 02 What's going on? Why such a different outcome? And that's when you realize, I think, pain is just a, it's a mysterious thing. And some people respond very differently. And even the same person may respond differently at different times. Like, if I had done Joanna Two's operation a week later, maybe she would have had a totally different outcome. And that would have been because she was less stressed, was better fed. You know, she hadn't had a difficult conversation with her mom. The weather was nicer outside. It's really wild, the things that you don't think matter can matter a whole lot when it comes to something like pain.
6:39 Marielle Segarra? Yeah. And I think that's where there's a lot of miscommunication around pain. And a lot of medical professionals can dismiss people's pain. Or if they're trying to say that there's a mental component, it ends up sounding to the patient like they're saying, you're making this up, or it's all in your head, or you just need to relax, when it's not quite as simple as that.
7:02 Speaker 02 The point you're hitting on, I think, has been one of the big challenges. The doctors I know, that's not their intent, to minimize. But the patient has to be the north star. I think that's what any good doctor will tell you. You have to listen to the patient and recognize that pain is, pain is pretty mysterious.
7:19 Marielle Segarra? Yeah. And be sort of humble, I think, about what we don't know.
7:23 Speaker 02 Yeah.
7:25 Marielle Segarra? Takeaway one. Pain can exist even in the absence of injury or tissue damage. It can also linger well after an injury has healed, even if you no longer have that body part. Of course, there, I'm talking about phantom limb syndrome. Also, researchers say that our surroundings and our emotions can affect our pain levels. And we can feel pain when our body perceives danger, even if there isn't any.
7:51 Marielle Segarra? There was this TEDx talk from a pain researcher in Australia. And he talked about how he'd been walking in the bush when he got bitten by a venomous snake. And he ended up having to go to the hospital, and it was really serious. And then after that, about six months later, when he had recovered, he was walking in the bush, and he felt this excruciating pain. And he assumed he'd been bitten again, but it turned out he'd just been scratched by a twig. So what is going on there? Like, what do pain researchers think is going on there?
8:20 Speaker 02 If you think about why pain exists, it could be physical pain, it could be mental pain, even existential pain. It mainly serves as a warning. It's alerting you to some sort of danger. And, you know, people's... Warning systems can be, have different sensitivities. But basically, the brain is like deciding, hey, be really careful here, be really careful. The best way I can tell you to be really careful is to give you pain. You're likely to, to practice avoidance behavior if I give you pain in this situation. So the brain's trying to make that decision. It doesn't always get it right. It, sometimes the pain can be way out of proportion to what it should be. But that same sort of phenomenon likely happened with this particular gentleman.
9:03 Marielle Segarra? Yeah. And I think that this can show up in chronic pain, right? The doctors can't find, in some cases, an underlying cause or an injury. Or maybe there used to be an injury, but now the tissue has healed and this person still has severe or consistent pain, or it just, it comes back and it goes away and then it comes back again.
9:26 Speaker 02 Yes. Chronic pain is, is pain that's occurring for at least three months.
9:30 Marielle Segarra? Okay.
9:31 Speaker 02 So they, they've tried to put a timetable on it, but there are people who have pain for decades. So, you know, it can last a really long time. Why that happens, it's still a really interesting and I think mostly unanswered question. Like, we understand why pain exists from an evolutionary standpoint, to teach you a lesson. Touch a hot stove hurts, don't do that again. Those lessons seem obvious. After the repair of the tissue, no ongoing tissue injury, and yet the pain persists. This gets into the much more mysterious aspects of pain. Sometimes you can find obvious causes. I mean, I'm a neurosurgeon, I take care of a lot of patients with spine injuries, but sometimes you don't.
10:14 Speaker 02 And, and I think the question becomes for a lot of pain doctors, so what do you do then? Do you start to probe for the emotional trauma? Do you start to probe for other things that could be potentially worsening this or amplifying the underlying issue? There's nothing off limits in terms of possibly contributing to pain, especially when that pain becomes chronic.
10:38 Marielle Segarra? Takeaway two: chronic pain is pain that's occurred for at least three months. Sometimes it happens after a known injury or trauma. The tissue heals, but the pain remains. And other times, there's no obvious cause. Sandre says there are still a lot of unanswered questions about why a pain turns from acute to chronic.
10:57 Speaker 02 I'll tell you, one of the things that fascinated me, just with regard to that chronification of the pain, just the role of inflammation, for example, at the time of injury. Let's say you get a sprained ankle, for example. Your ankle is swollen, it is red, it's painful. You want to do things to minimize inflammation. That's what we had long been told. One of the acronyms you probably heard: RICE, Rest, Ice, Compression, Elevate. All those things fundamentally decrease inflammation. But there was a paper that came out a couple of years ago that kind of really upended the thinking on this. It was these researchers who were trying to answer the question, who is more likely to have chronic pain? Like, what demographic of people?
11:42 Speaker 02 What is their medical history? What does their blood work look like? And the thing that they found that surprised them, and I think surprised everybody, was the people who had the highest levels of inflammation at the time of injury were the least likely to have chronic pain.
11:57 Marielle Segarra? Huh.
11:58 Speaker 02 So more inflammation at the time of injury, less likely to have chronic pain. Which is almost the opposite of what everyone thought. What are we to do with that? I mean, when someone's injured, you know, sprained ankle, whatever, I think what you're hearing now from pain doctors, they'll basically say, hey, look, lean into the pain, mobilize the joint, exercise even, use analgesia, pain medication if necessary, but don't use anti-inflammatories, and treatment. It's really interesting, you know, to tell people who are injured to get up and walk on it, or do whatever, because that's not what they're used to hearing. But it's almost like if you allow the body to do its job.
12:41 Speaker 02 If you allow those inflammatory molecules to rush to the scene and do their job, they do a pretty good job, and you're less likely to have chronic pain if you do that early mobilization and don't focus as much on decreasing inflammation.
12:58 Marielle Segarra? We'll hear more from Sanjay Gupta after the break.
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14:05 Marielle Segarra? Let's talk about some of the things that researchers say can help. So I had sciatic pain for a while. Sometimes it would flare up and it would be absolutely like throbbing. And I was speaking to a therapist who had me try this exercise. She said to focus on, I believe it was focus on the area that had pain, like focus intently on it for, I don't know, maybe it was like 20 seconds or something. And then toggle my focus to something else on my body that didn't feel painful at all. So I chose my ear lobe because it feels like nothing unless I touch it. And then focus on that for like 20 seconds and then toggle back to the part that hurt. And I swear it's like it turned the dial down on the pain.
14:49 Marielle Segarra? It went from throbbing, like maybe at a seven to a two or a three. It felt like magic at the time.
14:58 Speaker 02 Yeah, that's pretty incredible, you know? And for a significant percentage of people who have that sort of chronic pain with, again, without an underlying anatomical problem, which sounds like the case for you, it can be really effective. I will say, you know, when I looked at the data and I looked at data around. Similar protocols, there was one protocol in particular called MOR, which is mindfulness oriented recovery enhancement. And they would do similar things. They would say, hey, not only lean into the pain, but then also think of a pleasant scene. This sort of idea that, you know, the toxicity of the pain could be somehow remedied by thinking about something that was far more pleasant, you know, whatever it might be, flowers, sunset, time with your kids. And it seemed to be really effective in a percentage of people.
15:43 Speaker 02 Not everybody, to be clear. But for the people who, for whom it was beneficial, it was extremely beneficial. While they were actually undergoing the MOR protocol, for a period of time, they could take their pain scores down. The pain would come back. There is a half-life to these sorts of therapies. But the idea that, the type of therapy that you're talking about, Marielle, or this mindfulness oriented recovery enhancement, which has many components to it, could bring pain scores down that low for a period of time, was proof of concept of just how much of this is occurring in the brain and how much of that is in our control.
16:21 Marielle Segarra? Takeaway three. Brain training and mindfulness exercises are promising treatments for chronic pain where there's no identifiable injury. These exercises are free. You can do them at home. And they have no negative side effects. So why not try, right? They can include guided visualizations, body scans, where you mentally scan from your head to your feet and focus on the sensations without judgment, meditation and writing exercises, among other things. Also, talk therapy with a clinician who specializes in chronic pain could be helpful. They'll know about these kinds of exercises and it can help you work through tendencies that some researchers say are more common in people with chronic pain, like perfectionism. There are also apps that can walk you through these exercises and give you prompts.
17:05 Speaker 02 A lot of strategies that people use sort of in the bucket of mindfulness, different types of mindfulness. So like an analytical sort of meditation, where you are truly analyzing your pain and treating it as a curious observer, rather than having that pain inhabit your body. Like, I'm just gonna, oh, this is fascinating. Let me see sort of what's happening here. Oh, it's this shape. And it's that analytical versus the type of meditation where you might be thinking about something pleasant. There are all sorts of other therapies. I mean, there's emergency rooms around the country that will hardly use any opioids. They are called opioid-free or opioid-sparing emergency rooms.
17:43 Speaker 02 Besides things like meditation, they're using things like ketamine. You have patients who will get nerve blocks. So I saw an 80-year-old guy who came and fell, broke his hip. Very painful. Did not want narcotics and the ER did not want to give him narcotics. He got a nerve block. Took about 10 minutes for the nerve block. You have a team that comes down and does it. But he got faster pain relief in terms of how quick the nerve block kicked in than he would have if he had been given opioids. These are not new therapies, but I think opioids sort of just sucked all the oxygen out of the room for a long time. And a lot of existing therapies got minimized or even ignored. You're going to tell me to go be mindful instead of taking a pill? It just wasn't how people were thinking in this country.
18:28 Speaker 02 It's starting to change. But I think part of the reason I wrote the book was I wanted to show people the data behind this, you know, and give them some hope.
18:35 Marielle Segarra? Yeah.
18:36 Speaker 02 That there were other really, really effective options moving forward.
18:39 Marielle Segarra? Takeaway four, there are other options for pain relief besides opioids. And in addition to the mental exercises we talked about and painkillers like NSAIDs and acetaminophen. You might be able to get a nerve block or a trigger point injection, which is when your doctor injects a local anesthetic and sometimes a steroid directly into your muscle to treat painful knots. There are topical treatments like heat packs and lidocaine patches. Some doctors treat their patients with low doses of ketamine, which can provide rapid pain relief and be helpful when chronic pain flares. Also, there are lifestyle habits that might improve your pain levels. Regular movement, better sleep, an anti-inflammatory diet, and even connection, having friends, having community.
19:25 Marielle Segarra? It's helpful to know there are actually lots of things to try. You just have to get plugged into the right information or the right clinic. How easy is it to find a pain clinic or a pain doctor?
19:39 Speaker 02 It's challenging.
19:40 Marielle Segarra? Yeah.
19:40 Speaker 02 I mean, it is really challenging. And, you know, I think I had an audacious sort of thought when I was writing the book that... When you work in a hospital, especially if you're writing a book, you tend to see how things work. And you recognize that a lot of those things are adaptable into people's lifestyles. Pain doctors are remarkable people because frankly, they're everything. They're like these Swiss army knives. They're doctors, they're psychologists. They understand techniques, they know how to do nerve blocks. Obviously, many of those things you could never possibly do at home. But I think there's a lot of things that you can do. And there's lots of reasons why we are hurting more than ever. And many of those things are within our control.
20:24 Marielle Segarra? Sanjay, thank you so much for this. It's been really nice to talk to you.
20:28 Speaker 02 I could talk about this all day, you know?
20:30 Marielle Segarra? Same.
20:33 Marielle Segarra? All right, time for a recap. Takeaway one, pain can exist even in the absence of injury or tissue damage. It can also linger well after an injury has healed. And researchers say that our surroundings and our emotions can affect our pain levels, too. Takeaway two, chronic pain is pain that's occurred for at least three months. And sometimes this happens after a known injury or trauma. Other times, there's no obvious cause. Takeaway three, brain training and mindfulness exercises are promising treatments for chronic pain where there's no identifiable injury. These can include guided visualizations, body scans, writing exercises, meditation, and more. Also, talk therapy with a clinician who specializes in chronic pain could be helpful for you.
21:19 Marielle Segarra? And takeaway four, there are other options for pain relief besides opioids. And alongside those mental exercises and painkillers like NSAIDs and acetaminophen, you might be able to get a nerve block or a trigger point injection. There are also topical treatments like heat packs and lidocaine patches. And some doctors give their patients low doses of ketamine. Also, some lifestyle changes might help with chronic pain levels, including regular movement and sleep, an anti-inflammatory diet, and connecting more often with other people.
21:52 Marielle Segarra? And that's our show. While you're here, though, what do you think about rating and reviewing Life Kit in your podcast app? Here's a recent review I liked from listener Fwalter819. The subject line, "Admit it, you need this too. Having learned many of these lessons the hard way, I recommend Life Kit instead. And for all the lessons they cover that I never learned, thanks. Better late than never." Thanks for listening, Fwalter819. This episode of Life Kit was produced by Margaret Serino. Our digital editor is Malika Gharib, and Megan Cain is our senior supervising editor. Beth Donovan is our executive producer. Our production team also includes Andy Tagle, Claire Marie Schneider, Sylvie Douglas, and Mika Ellison. Engineering support comes from Tiffany Vera
22:35 Marielle Segarra? Castro. Fact checking by Tyler Jones and Barclay Walsh. I'm Marielle Segarra. Thanks for listening.
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23:04 Speaker 00 This message comes from Midi Health. Most women never get real answers about their hormonal health. Midi is changing that with virtual care covered by most major insurances. Understand your hormones. Visit joinmidi.com to book your first visit today. This message comes from Data IQ Agent Management. Most enterprises can count every device, every login, and every contractor. Almost none can count their AI agents. Take control of your agentic workforce with one view across every platform and tool, showing what's driving revenue, what's drifted, and who signed off on it. Visit dataiku.com. That's data i k u dot com.
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