The Answer to Pain May Lie in Your Brain
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Hello and welcome to a special episode of Chasing Life. We are going to be doing things a little differently today, starting with the host. As you may have noticed, I am not Dr. Sanjay Gupta, but don't worry, he is alive and well, and he's here.

My name is Ben Tinker. I'm the head of the health team here at CNN, and I have worked with Sanjay for 14 years now. It's really, really hard to believe. We are flipping the script today because Sanjay has a new book coming out this fall. It's called It Doesn't Have to Hurt, Your Smart Guide to a Pain-Free Life. It is available to pre-order now, but we wanted you to hear about it first and directly from Sanjay. So let's jump right in.

All right. What a tough booking. Dr. Sanjay Gupta, welcome to your own podcast. How does it feel to be on the other side of the mic? It's a little strange. I'm not going to lie. And then I look at you and you have Chasing Life with Dr. Sanjay Gupta behind you. So that feels very meta. So it's a privilege to be here with you. Yeah. Thank you.

And Sanjay, I want to start by quoting you to you, which I hope is okay, but I'm running things today, so I guess it is okay. In a report we did years and years ago, I remember you saying that here in the United States, we take 80% of our

80% of the world's pain pills, but we do not have 80% of the world's pain. That stuck with me even this many years later. How big of a problem is pain here in the US, but also around the world? Pain is one of these things that I find very interesting because I think for a lot of people, it is such a personal experience. I don't know how to measure pain directly. If you tell me you're in pain, that can mean a lot of different things.

But I think with regard to pain medication consumption overall, we're about 4% of the world's population in the United States. And when it came to certain opioids, we were consuming 80% to 90% of the world's supply. What is interesting about that, Ben, is that I think pain is actually, chronic pain at least, is distributed pretty evenly around the world. And the numbers actually I found quite shocking. About 20% of people in the United States, but also around the world,

have chronic pain. That's a staggering number. I mean, that means basically every day your life is defined by pain. I didn't realize that until I started really researching the book. But I think even more to the point is that for a long time, there was really nothing that people felt like they could do about it except take these pills that we're talking about.

So the pills were just more widely consumed in the United States. I think the tolerance for chronic pain was a lot lower in the United States. But chronic pain as an entity is a very, very common phenomenon, growing faster as a chronic disease class than diabetes or heart disease. People are in pain and the numbers are growing.

So I'm sure this topic, like you said, is going to resonate with a lot of people if they don't deal with pain in their everyday life. And a lot of people do. Maybe it's a parent, it's a partner, it's a friend, it's a coworker. For you, though, it was your mom's encounter with pain that was actually the impetus to write this book. I've known you for a long time. I've been lucky enough to know your mom almost as long as I've known you. And I always think about her as a really youthful, energetic, and pretty carefree person.

I hope she's listening. What happened?

She had a fall, and it was seemingly a relatively innocuous fall. She was wheeling her suitcase, and she sort of fell backwards into a sitting position. So it wasn't, you know, like down a flight of stairs or anything more alarming like that. But still, when you're in your 80s and, you know, older bone, more osteoporotic bone, it led to a pretty significant spine fracture. It was very jarring, I think, to see somebody, you know, like that, and in this case, obviously, my mom,

suddenly develop really, really profound pain. She just doesn't complain. She had breast cancer years ago and treated it sort of like a blip on the radar, you know, barely talked about it. I remember that, which is why I remember this feeling so different that it had such a bigger impact on her physically, mentally, and I think emotionally too, right?

She wanted to die, Ben. I mean, she basically said, look, if this pain continues the way that it is, I just think my time here is done. That's how she phrased it, which, you know, even saying those words out loud still today, it gives me a pit in my stomach, you know, to say that. But it really was a staunch reminder, even as a doctor myself, to take care of, in this case, my mom, but also a patient, that once you have chronic pain, it is your whole life.

I mean, if you have diabetes, it's not like you don't have diabetes. You're not thinking about it. But you're not consumed by it all the time. When you have pain, it is your identity. How are you doing? I'm in pain. You wake up with pain. You go to bed with pain. You can't do certain things in your life because of pain. You know, your personality changes.

The book is really about chronic pain, which is what you're talking about. But before we dive deeper into that, I want to ask you about acute pain. No one likes feeling it in the moment, or I should say probably very few people like feeling it in the moment, but it serves a really important purpose and can actually be a good thing. And I was hoping you could talk a little bit about that. Yeah. I mean, there's an important distinction between acute pain and chronic pain. Even though they both have pain in the title, I really, again, as a

as part of writing this book, came to think of them as almost entirely separate entities. They're really different diseases or different disorders entirely. Acute pain, you know, you slam your finger with a hammer, you touch a hot pan, whatever it might be,

It teaches you a lesson in that moment to be more careful, to not do something. There is an evolutionary aspect to acute pain. Having said that, it is very, very different, acute pain, person to person, and even within the same person, moment to moment. Like if you were to bang your finger with a hammer on a Tuesday morning, you know, before you'd eaten, before you'd had coffee, whatever, and

It might hurt a lot more than if you did that exact same injury on Wednesday, well-fed, nice day, already had your coffee, whatever it might be. So even within the individual, pain can be highly, highly different between people, which is part of the enigma, right? Like, you know, you're going to throw one sort of therapy at people. Not only does that not make sense for the population as a whole, it doesn't even make sense for the individuals specifically.

That is how unique pain is as a sensation. And it's hard to score, right? I mean, that's been one of the main challenges of this. How much pain are you in on a scale of one to 10? As you're saying, my four could be different than your four, but my four is different than my own four on a different day, right? Yeah.

Absolutely. It's very hard to measure. And it's just the scoring is exactly what you've described. I mean, that's all we've really had were these, you know, kind of smiley face charts, which people may recognize when they go to the ER or the doctor's office. Zero to 10, you know, frowny face, happy face. It's weird. And when we spend four and a half trillion dollars on health care, this is the largest disease growing class ever.

in the United States, probably most places around the world. And yet, unlike biomarkers that we talk about for Alzheimer's disease or lipids for cardiac disease, we literally have a smiley to frowny face chart to measure this really important class of problems for people. So to dive deeper into this chronic pain issue then, in reporting out this book, where did you find that that came from for most people? Is it an accident? Is it a surgery? To some extent, is it genetics?

It can be all those things, but it's mostly, it's really what we refer to as noceoplastic pain, which sort of more strictly defined just means we don't know where it came from. There's no obvious origin. Yes, there are people who get in accidents and their pain doesn't resolve.

They have falls like my mom did. It doesn't resolve. Having had an operation or something could lead to a pain that does not go away. And so there are those reasons. But the idea that for a lot of people, if you were to ask them,

Like, when did this start? What started it? For most people, they're not going to really have a very clear-cut answer to that. Maybe they say, I took a funny step down the stairs, or, you know, I hit my head on the car door as I was trying to get into the car. Something like that they may say.

But the idea of being able to trace it back to a moment in time, that's not typical. That's interesting. I actually thought the answer would be that it was tied to one specific event. But this makes it, to your point, even harder to pin down how bad it is, what the treatment should be, what the prognosis is going to look like. I'll say one other thing. And this was a statement that when I was doing one of these interviews with these physicians out of Mayo Clinic who run a pain clinic.

The sort of point that this doctor was making to me, and we were revolving around this for a while, because it's a bit of a provocative and in some cases even controversial point, but her point was that chronic pain hardly ever occurs in isolation. It comes with baggage. And most often that baggage are things like depression and anxiety.

So, you know, I think when other physicians have suggested this in the past, there was a guy named Dr. John Sarno. For anybody who follows the pain world, they'll know his name. But he basically said that almost all, in fact, he said all chronic pain is psychosomatic. And, you know, as you might imagine, that didn't sit well with a lot of people because I think the immediate interpretation was it's all in your head. Right.

But the fact of the matter is, from just a pure neurological perspective, all pain is in the brain. If the brain decides you don't have pain, you don't have pain. And by the way, if the brain decides you have pain, then you have pain. Take phantom limb pain, for example. The brain can create pain in parts of the body that don't even exist.

So if you just think about that as a concept, then you realize that the brain is the ultimate sort of commander of pain.

That's such a wild phenomenon, right? I mean, in addition to being CNN's chief medical correspondent, for anyone who doesn't know, listening to the podcast, you are a practicing neurosurgeon right here in Atlanta. You are literally inside people's brains every week. When you're talking about the way that the brain creates pain, especially in a limb, like you said, that doesn't exist,

What is the mechanism by which that happens? I mean, do you know? Does anybody know? How does it create it? But also, how can it eliminate it? I think this is sort of really getting at the core of what you're writing about in this new book.

For sure. I mean, I think for a long time there was sort of this reductionist sort of approach to pain in the brain, meaning let's see if we can find a center for pain in the brain. And maybe if we could target that center like we would with Parkinson's disease, for example. We have a pretty good idea if we target a certain area of the brain called the substantia nigra for Parkinson's, we can help treat someone's tremor, right? You've seen those procedures where someone puts a deep brain stimulator and all of a sudden the guy's tremor goes away.

That's kind of a reductionist sort of way of looking at things in the brain, but for certain things it works, like Parkinson's. With pain, if you do these functional MRI scans on people who are in the throes of pain, you see all these different areas light up.

which I think was surprising. There are certainly areas of the brain that I think are sort of the command central. They're sort of the relay board. But pain has this very circuitous route through the brain. That's why it's so dependent on mood and past events and, you know, your anticipation. Anticipation of pain is a big thing. If you tell a child, for example, this is going to hurt, it's going to hurt. And by the same token, if you say this is not going to hurt,

You know, some parents may say, well, I'm not being totally honest with my kid, right? Why would I say it's not going to hurt? It's a needle going into the skin or whatever it may be. But the reality is that makes a difference because you are actually activating circuits in the brain that are turning off the intensity of that pain.

Absolutely fascinating. I think if you were to ask anyone who's listening, what do you think is the best way to manage pain? A lot of people might say with pills, right? I mean, a pill for every ill, the saying goes. How effective are some of these medications and what really is the best way to manage chronic pain? Again, after you've gotten through that acute trauma. The discussion on opioids is sort of an interesting one in this regard, Ben, because I think that...

they've become very maligned, these medications. I think people have laid the epidemics of addiction sort of at the feet of opioid prescribing. And I think, you know, for good reason, there's been a lot of blame to go around. But on the other hand, I think to your point, they can be very effective medications as well. And that has, I think, been the dilemma for a lot of people. There are a lot of people who use these medications very, very responsibly and

And those people have run the risk of having those medications taken away or not being able to get prescriptions as easily. So they can be highly, highly effective. But the problem is not a complicated one. It's just that we've overused it. I mean, we are a culture of consumption.

So we've taken this sledgehammer of a therapy, which can be very effective, and basically sort of used it for just about everything. Skye, my daughter, who you know, my second daughter, she went to get a dental procedure not that long ago, and she walked out of there with a prescription for Vicodin. I was shocked. We way overuse these medications, and that's part of the problem.

Having said that, we also realize that for most of these pain conditions, they can cause longer term problems. More chronic pain is associated with the use of opioids. So even though it may be very good at alleviating the pain in the moment, as you say, or in the short term,

People do tend to have more likelihood of developing chronic pain in part for a very simple reason. When you're taking these medications, it basically turns off your body's own endogenous opioid system. So all of a sudden, if you don't stay on the opioids, you will have pain because every little thing will hurt because your endogenous opioid system is now turned off or turned way down.

So it's an understandably good short-term proposition, a terrible long-term proposition for most people, but highly effective, you know, certainly in the moment. We're going to take a quick break. And when we come back, more with special guest, Dr. Sanjay Gupta. This podcast is supported by Wonderful Pistachios.

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Earlier this year, the FDA approved the first new type of pain medication in 25 years, which is really hard to believe that had been that long. You told me the development of this drug has a really interesting story behind it.

Yeah, I love the story. This is just one of those sort of, I guess, real world to bench sort of backwards retroengineering of a medication. So as you point out, first of all, 25 years, quarter century, no new medications for pain. To give you some context, the FDA will typically approve 40 or so, 40 to 50 medications a year. And I

And again, all the things we said, pain, huge concern, huge issue, fastest growing disease class in the United States around the world and no new meds.

for a quarter century. So, you know, just let that sink in. And a big incentive too, right? Like there's a big market for this as well. So you would think that of all the drugs being developed and coming to market, there would be a lot of these. You would think, and I think this is probably almost a different podcast sometime, but how opioids sucked up all the oxygen in the room for so long. I think the fact that we have not had any new pain meds in 25 years, how exactly that happened, because it's not for lack of trying.

There are a lot of people trying. I think the last one that was approved was Celebrex, and that was in the late 1990s. But this medication, basically there was this family, initially this 14-year-old boy, but this family of people who were these circus performers, street performers in Karachi, Pakistan. And they could do these incredibly dangerous things. They would take these sharp objects and put them through their appendages, like their hands or their feet and stuff like that.

And they could walk on really, really hot coals, which you've heard of hot coal walkers in the past. But most people who walked on hot coals, the reason they could do it is because their feet are essentially numb. They don't feel anything. What they found with this group of people was that they could feel the coals. They could feel the texture of the coals on their feet. They could feel that the coals were hot, burning even. What they did not feel was that the coals were painful.

That was unusual because they had sensation and they could tell hot cold. It was only pain. Pain was the only sensation that they seemed to be lacking. So these researchers, again, this is a fascinating story. They went and studied this family. They found that they had a gene. And then for a quarter century, they essentially retro-engineered the impact of that gene into a medicine.

And that became the first FDA-approved medication in the spring of this year. The first FDA-approved in more than 25 years happened in the spring of this year. It's an incredible story. The medicine's called suzetrogene. I think it's going to, you know, it's out now. Doctors can prescribe it. It's going to take a while for it to become as common. And maybe for a lot of people who are listening to this, they've never even heard of this medication before.

But I think it's going to be a really good alternative to opioids for a lot of people. It does not sedate, does not lead to addiction. It works in the peripheral nervous system, not on the brain. So, you know, I think it's going to be a really good option.

And another tool in the toolkit to try, right? That's right. In addition to pills, these pills, the opioid pills, all the pills, or maybe even instead of them, ideally for some people, how important is someone's diet when it comes to managing or eliminating their pain? I know you're a huge proponent of doing things as naturally as possible.

Medication absolutely has a place in all of our lives at points, but what can people do about it with the food and the drinks that they consume? I think there's a lot that can be done with food. And I think the way to sort of think about it conceptually is that going back to why some people experience more pain than others for the same injury or the same insult.

There could be a lot that's baked into that, but one of the other things that's sort of underlying it is just the amount of baseline inflammation that you have in your body at any given time. So if you're in a, if you're just think, imagine if you're in a more inflamed state and

and then you suffer some sort of injury, that's going to feel a lot worse. It's going to cause a lot more pain than if your overall inflammation level was low. And you can imagine that however you want. Imagine if your skin was inflamed, then you hit it. That's going to hurt more than obviously if your skin wasn't. Same sort of thing, just apply that to the whole body.

So, you know, I'll tell you, interestingly, we talked about my mom, but as you know, Rebecca, obviously, as well, my wife, who has dealt with autoimmune issues her whole life. And when you deal with autoimmune issues, you basically have a high level of baseline inflammation in your body.

And so as part of treating that, she went on a anti-inflammatory diet, very, very strict, you know, and as a good husband, good partner, I decided to do it alongside her as a show of support. And I'll tell you, it was really interesting. I think it's worth exploring that for all sorts of different reasons, but decreasing baseline inflammation, really important.

One thing you've also started to talk a lot more about is social prescriptions. What does that look like? Obviously, you know, a lot of people have made a lot of hay about the loneliness epidemic in this country. What does that look like when it is, you know, quote unquote, prescribed by a doctor? But I think you would also say you don't really need a doctor to prescribe this for you. You can do this for yourself. You absolutely can do it for yourself. I think doctors started thinking about this as a prescriptive sort of thing, even when it came to prescribing drugs.

certain foods, certain levels of activity. You always thought of doctors as just prescribing medications.

But you had these groups of doctors in the United States and in Canada who started making prescriptions for the national parks, for example. You must visit a national park once a month or something. And I thought it was sort of interesting. Can I get that prescription from you, by the way? I know, right? I love that. Dr. Lem out of Canada, I think she was the first to start doing it. And I just thought it was really interesting.

But I think the thing that really provoked it for a lot of people were actually these studies that showed people in isolation tended to activate some of the same pathways that we were just talking about as people who had suffered physical pain. So the idea that loneliness and isolation hurts physically.

We think of that as purely, you know, a mental thing or emotional thing, but the idea that it hurts physically, I think, was sort of a revelatory concept. And the idea that it hurts all on its own, but then could exacerbate other things. So going back to slamming your finger with a hammer or something,

If you do that to a lonely person versus a person who has a lot of social connections, it's going to hurt more for the lonely person. Because their brain has changed. Their brain has changed. Their brain is more amped up. Call it that. Their brain sees threats more easily.

I think when you're lonely, you know, from an evolutionary standpoint, the way that it was explained to me was that in a way you feel like you've been cast out of the tribe. And when you're cast out of the tribe, you feel like you're less protected. You're kind of on your own. And you have to be more suspicious of everything. Your threat detector level has to be higher because everything is a potential threat.

The people in my life, for the most part, when they're hurt, myself included sometimes, they don't really want to work out or get a lot of exercise. Is exercise something you should avoid when you're dealing with pain? Or, I'm just taking a guess here, could some types of exercise in some situations, if done the right way, actually help alleviate pain? I think it's absolutely the latter. And as simple as this concept may sound, this was a big one for me in the book.

Even as a physician, I mean, you know, let's say you've twisted your ankle or something like that. I think most people, and for good reason, would say, you know, adopt some form of the RICE protocol, which is rest, ice, compression, elevation. Okay, so you just imagine that ankle, you're resting it, you're icing it, all that.

And there was a study that I read that for me really turned that kind of advice totally upside down. And I think one of the things that I sort of took away from it is that you mostly want to let the body do its job. You want to let those inflammatory molecules that are going to that site of your twisted ankle or whatever it might be and do their job.

And so instead of rice, this gets to your question, I think the acronym that a lot of people that I interviewed are now sort of referring to is MEAT, which is Mobilization, Exercise,

analgesia if needed, and treatment if necessary. So unless your ankle is broken, you should probably be moving it and exercising it. You do want to increase the inflammatory molecules blood flow to that area because even though it may hurt a little bit more in the moment, it'll dramatically reduce your chance of it hurting later. What, if anything, should I make that both of those acronyms are food? Sometimes

it's the simplest things that make the most benefit. I've known you a really long time. You're not a fad guy, but you've really become a major proponent of foam rolling. What has this done for you? And what do you think it could do for people who are listening who maybe never tried it? They didn't think it was worth it. But I will say, if you want to do it, it's pretty cheap too. Pretty cheap. And you can do it yourself. Here's the way I sort of looked at it. You know, when I was thinking about the book, I really wanted to talk about this idea that

much of pain is preventable. I'm talking about like even how much does your body hurt after you work out? You know, how much does your body hurt after a really hard day? I found when I foam rolled and just doing like large muscle groups and things like that, I'm basically loosening up that myofascia. I'm loosening up that thick fibrous envelope around my muscles and tendons and everything and

that tends to get a little bit tighter, I think, as we get older. So if you have swollen muscles after a long run or something and they're trying to swell against a thicker, fibrous envelope, it hurts more. So making sure those are loose, as loose as possible, I think, is really helpful in terms of preventing injury or preventing pain, I should say, or at least preventing the intensity of the pain.

If it's okay, I thought we could end with a little lightning round just to put you on the spot a bit. Oh, love it. Okay, this is painful. No, it'll be good. And a fun kind, too. If you could only eat one food for the rest of your life, what would it be? Lentil soup.

Really weird choice. I didn't say it had to be good for you, but if you got to just choose anything. No, no, I think, well, I think if you're going to do it for the rest of your life, I think unless you want to die quickly, you have to pick something that's reasonably good for you. Like I could say ice cream, but then obviously that's not going to sustain itself. Well, hey, listen, good luck with your lentil soup. Okay. If you could have any superpower, what would it be? Instant healing. Wow. The doctor in you coming out.

What non-existent job do you wish existed? You'll appreciate this one. All right. It's crazy. Weather choreographer.

I want to be able to choreograph the weather for events and things like that. I think there's a high likelihood that will be a thing in the very near future. Do you ever use the five-second rule and eat food you dropped on the floor? All the time. Excellent. Absolutely. Are hot dogs sandwiches, and when is the last time you ate one? Hot dogs are not sandwiches, and I hate hot dogs. I don't eat them. I won't even talk about it. It's out of my mind. Okay.

Hey, that was a lot of fun. Thank you so much for letting me sit in your chair. Thank you to everybody for listening. I hope you learned as much as I did. Please don't forget you can order, pre-order Sanjay's new book, It Doesn't Have to Hurt Today. That way it will be at your door on publication day, which is Tuesday, September 2nd. And since your name is on the screen right here, I do have to give you the last word. So over to you. Thank you for letting me talk about this topic. You know, I think there's a lot of things in life that we think are

are sort of out of our control. We just sort of accept the status quo. I think we talked about it a lot

for other things like Alzheimer's disease, nothing you can do about it. Now we know that's not the case. Cardiac disease, we know that's not the case. I think a lot of the reasons that I do this job is because it's very empowering and very inspiring to see what is possible. And I think, you know, for people like my mom who, you know, were defined by pain, there's a lot of hope out there. So I hope people can find that hope. Me too. Sanjay, thanks. You got it.

Chasing Life is a production of CNN Audio. Our podcast is produced by Aaron Mathewson, Jennifer Lai, Grace Walker, Lori Gallaretta, Jesse Remedios, Sophia Sanchez, Kira Daring, and Madeline Thompson. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Seeley is our showrunner. Dan DeGiula is our technical director. And the executive producer of CNN Audio is Steve Liktai.

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