When neurosurgeon and journalist Dr. Sanjay Gupta set out to write a book about pain, it wasn’t because he had all the answers but because he remained 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 recent developments in pain science, drawing on patient care and conversations with researchers and doctors. One surprising finding: simply learning about pain and how it works appears to relieve pain for some people with chronic conditions.
Gupta, who is also CNN’s chief medical correspondent, explains what we still don’t know about pain and highlights effective newer treatments.
The brain decides whether you have pain
Gupta emphasizes that the brain sits at the center of any pain experience. “If the brain doesn’t decide you have pain, then you don’t have pain,” he says. The brain can also produce pain where there is no obvious physical cause — phantom limb pain being a classic example. People vary widely in how they experience pain, and the same person may respond differently at different times.
He illustrates this with the story of two patients named Joanna who had similar problems and operations on the same day. The day after surgery, one Joanna was up, groomed, and discharged; the other was miserable. Small differences — stress level, nutrition, weather — can meaningfully influence pain outcomes. “The things you don’t think matter can matter a whole lot when it comes to pain,” Gupta says.
Chronic pain remains poorly understood
Chronic pain is typically defined as pain lasting at least three months, but for some people it persists for decades. Why pain becomes chronic for some and not others remains largely unanswered. Gupta says virtually anything could contribute when pain becomes chronic — biological, psychological, social factors — and nothing should be ruled out.
Mindfulness-based treatments can help
Gupta highlights mindfulness therapies such as meditation and breathing exercises. He points to Mindfulness-Oriented Recovery Enhancement (MORE) as a protocol that has helped a significant percentage of people with chronic pain without an obvious anatomical cause. MORE teaches people not to lean into pain but to shift attention to pleasant scenes or experiences — sunsets, flowers, time with loved ones — reducing the “toxicity” of pain. The fact that such approaches can lower pain scores underscores how much of pain is processed in the brain and is, to some extent, controllable.
Rethinking injury care: from RICE to MEAT
For acute injuries like ankle sprains, Gupta notes a shift away from the long-standing RICE approach (rest, ice, compress, elevate), which suppresses inflammation. A study found that people with higher inflammation at injury were less likely to develop chronic pain. That has led some clinicians to recommend MEAT: movement, exercise, analgesia, and treatment. Early mobilization and appropriate use of pain medication — rather than immediately suppressing inflammation — may reduce the risk of chronic pain.
A broad menu of options
Gupta urges patients and clinicians to maintain a wide menu of treatment options. “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.”
For more treatments and therapies, listen to the podcast episode of this interview. This interview has been edited for length and clarity.
This story was edited by Malaka Gharib. Leave a voicemail at 202-216-9823 or email [email protected]. Listen to Life Kit on Apple Podcasts and Spotify, and follow @nprlifekit on Instagram.