Chief Medical Correspondent Dr. Sanjay Gupta has just released his new book titled “It Doesn’t Have to Hurt,” which delves into pain management. There’s also a special report set to air on CNN at 9 p.m. ET on September 7, highlighting the same themes.
A few years ago, while in the operating room laden with advanced equipment, I couldn’t help but notice that the patient before me had used a simple frowny face to express their pain. After over 25 years in neurosurgery, I’ve seen countless cases where pain serves as the initial signal that brings people to seek medical help. The challenge is that pain is a subjective experience; it doesn’t easily fit into objective measures. This feeling, universal to humanity, remains difficult to articulate.
As I worked on my book about pain, I honestly felt that the topic seemed exhausted. Many books and documentaries have already covered the opioid crisis over the past couple of decades. However, it struck me that while opioids dominate the conversation, vast alternatives for treating pain without them were largely ignored, even by my peers in the medical field.
The opioid epidemic, driven by arrogance and greed, left little room for discussing other pain management methods. While it’s true that for some, opioids can be lifesaving, it’s also important to note that our bodies produce their own natural pain relievers, known as endorphins. This system not only helps mask pain but also improves mood. Yet, when one takes opioids, their body reduces its own endorphin production, which is why opioids are rarely suitable for ongoing chronic pain. Over time, they might become less effective, and paradoxically, people end up feeling more pain.
However, my book doesn’t just focus on opioids. I wanted to emphasize that pain encompasses both physical and emotional dimensions, differing vastly from one person to another.
Quantifying pain isn’t straightforward like measuring cholesterol or a tumor size. There have been times I wish I could experience my patients’ pain to grasp their struggles better. I’ve also felt that way with my daughters when they complain about their own aches and injuries, wishing for a way to truly understand their feelings.
Pain is, in many ways, a complex enigma in medicine. Not only is it unique to each patient, but it can also fluctuate within the same individual. One day, you might stub your toe and feel a different intensity of pain depending on what else is happening in your life, such as stress or a troubling phone call. Factors like past trauma, anxiety, or depression can further complicate one’s pain experience.
As someone once said, “Chronic pain never occurs in isolation.” It often drags along emotional baggage that’s as important to consider as the pain itself. Many patients often feel that their pain is dismissed, hearing those frustrating words suggesting it’s all “in their head.” Yet, to some extent, it is. The brain plays a significant role; if it decides there’s no more pain, then, well, there isn’t. The mind has the power to alleviate pain or, conversely, to magnify it, as seen with phantom limb pain.
Your expectations and past experiences shape your perception of pain. When you anticipate discomfort, even minor injuries can feel more intense. Conversely, if you approach an injury expecting minimal pain, your body often can cope surprisingly well.
This exploration of pain mainly pertains to chronic pain, which usually persists for at least three months. For many, it can endure for decades, sometimes becoming a lifelong battle. Acute pain and chronic pain are fundamentally different, even affecting distinct brain areas.
While writing this book, I sometimes wished we could rename these pain types, it feels so peculiar how separate they are. Acute pain, like the sharp sting from touching a hot surface, serves as a necessary warning. Chronic pain, on the other hand, is puzzling; its purpose, if it even has one, remains elusive.
Some experts have likened chronic pain to a broken record, replaying the same painful message continuously. One physician-poet vividly described it as “a memory that cannot be extinguished.”
Chronic pain, as noted in Bessel Van der Kolk’s insightful writing, pushes us to explore deeper issues. Even if our minds forget past traumas, our bodies might still carry that unresolved pain, reminding us of its unpredictable nature.
Nobody actually enjoys experiencing pain, right? Yet, it seems that in the U.S., our aversion to pain is particularly pronounced. Although we make up only a fraction of the global population, we consume the majority of the world’s pain relief medications and engage in numerous surgical interventions for pain.
In contrast, other countries take a different approach. In Japan and China, for instance, it’s common for colonoscopies to be performed without any sedation. In Finland, only a small percentage of patients are sedated for these procedures, whereas in the U.S., that figure is nearly universal.
I can relate; I had sedation during my colonoscopy and can’t imagine undergoing it without. Yet, I realize that my expectations are shaped more by culture than by any shared human experience.
Fortunately, changes are on the horizon. This summer, I found myself at Maimonides Medical Center in Brooklyn, New York, a distinguished trauma center catering to a diverse community. An ER doctor informed me that they communicated in over 120 different languages there.
This facility also practices what’s known as opioid optimization, meaning they rarely use opioids, and only as a last resort. Instead, I witnessed doctors employing nerve blocks, ketamine, and even combining ibuprofen with Tylenol for pain management.
While there, a 76-year-old man received treatment for a fractured hip; rather than defaulting to opioids, a doctor opted for a nerve block that dulled the pain effectively. Meanwhile, a 67-year-old woman suffering from knee pain found relief through a virtual reality experience as she was transported to an idyllic beach, significantly reducing her pain score.
I often think about this woman’s story as I watch my own mother struggle with discomfort. My mother, who has always been resilient and rarely complained about pain throughout her 80 years, faced a severe challenge following a fall that resulted in a broken vertebra. When I arrived to check on her, she was visibly grimacing at the slightest motion.
When I inquired about her pain, she rated it as an astonishing 80 out of 10. “If I can’t get rid of the pain, I don’t want to live like this anymore,” she confessed to me. Writing those words still tugs at my heart. In a matter of days, her pain redefined who she was. Thankfully, a kyphoplasty procedure that stabilized her broken vertebra provided much-needed solace, alongside meditation we practiced together.
I watched as she sat quietly, visualizing her painful spot for 15 to 20 minutes. Remarkably, her pain score dwindled to zero during that time. While the pain returned later, it was a striking example of how the mind can influence the body’s perception of pain.
In the United States, about 21% of adults—over 51 million people—live with chronic pain. Of this group, 17 million find their lives drastically restricted by it. Chronic pain rates are surging, and many people feel like their bodies have betrayed them, leaving them to believe they will never be pain-free again. However, after my extensive research, I firmly believe that this doesn’t have to be the case.
With the right approaches, it is indeed possible to alleviate, diminish, and even prevent pain. It’s not an inevitable part of aging. With open-minded strategies, anyone can embrace the belief that “It Doesn’t Have to Hurt.”
