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 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 experience with patients and conversations with researchers and doctors. What he found may challenge how you think about pain and even give you tools to feel better. There’s evidence that simply learning about pain and how it works “seems to be pain relieving” for people with chronic pain conditions, he says.
Gupta, who is also CNN’s chief medical correspondent, explains what we still don’t know about pain and shares a few effective treatments.
The brain is central to pain
A major development in pain treatment is understanding 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,” Gupta says. The brain can also create pain where there is no obvious physical cause — phantom limb pain is a classic example that long puzzled doctors.
People respond to pain differently, and the same person can respond differently at different times. Gupta tells the story of two patients named Joanna, operated on the same day for the same problem. The day after surgery, Joanna No. 1 had put on lipstick and combed her hair; she was discharged soon after. Joanna No. 2 was miserable. Small factors — stress, nutrition, weather, mood — can strongly influence pain outcomes. If Joanna No. 2’s surgery had happened a week later, her experience might have been very different.
Chronic pain remains mysterious
Chronic pain is defined as pain lasting at least three months, but some people suffer for decades. Why pain becomes chronic in some people and not others is still largely unanswered. Almost anything could contribute to chronic pain — biological, psychological, social factors — and no single explanation fits all cases.
Mindfulness and MORE
Mindfulness therapies, including meditation and controlled breathing, can be effective for managing pain. One protocol Gupta highlights is Mindfulness-Oriented Recovery Enhancement (MORE). For many people with chronic pain without a clear anatomical cause, MORE can reduce pain scores. Practitioners encourage patients not to focus only on the pain but to imagine pleasant scenes — sunsets, flowers, time with loved ones — which can counteract the “toxicity” of pain. That such techniques can lower pain provides more evidence of how much pain is generated or moderated by the brain and how much is within our control.
Rethinking injury care: RICE vs. MEAT
Longstanding advice for injuries like ankle sprains has emphasized RICE — rest, ice, compress, elevate — to reduce inflammation. Newer research challenges that approach. A study looking at who develops chronic pain after injury found that people with higher levels of inflammation at the time of injury were actually less likely to develop chronic pain. Based on this and other work, many pain specialists now recommend leaning into movement and early activity rather than simply suppressing inflammation.
The newer acronym Gupta cites is MEAT: movement, exercise, analgesia, treatment. Meaning: mobilize the joint, exercise, use pain medication if needed, and pursue appropriate treatments, rather than prioritizing anti-inflammatories. Early mobilization appears to lower the risk of developing chronic pain.
Have a menu of options
When dealing with something as complex as pain, Gupta advises having a broad menu of options. Nothing works for everyone, but there is likely something that can help most people. Education about pain, mindfulness-based approaches, appropriate movement and rehabilitation, and targeted medical treatments can all be parts of an effective plan.
For more treatments and therapies from Gupta, listen to the podcast episode. The story was edited for length and clarity. Life Kit welcomes feedback by voicemail at 202-216-9823 or email at [email protected]. Listen to Life Kit on Apple Podcasts and Spotify, and sign up for the newsletter. Follow @nprlifekit on Instagram.