Dr. Sanjay Gupta wants you to reframe your understanding of pain

Hey, it's Mariel.

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. They would say meat.

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 learned that actually inflammation after

an injury can be a good thing. 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. 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 U.S. are currently dealing with chronic

pain. "We hurt our world hurts." 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 LifeKit, I talk to Sanjay about some of the surprising developments in pain science, including non-opoid 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. 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?

“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 has baffled people, like the limb doesn't even exist anymore. These have been long 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. 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 perform 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. This story of the two Joanna's, it just so happened that I ended up operating in two women on the same day that basically had the same problem, and we're very, very similar.

Not only in terms of what the medical issue was, but in terms of they themselves around the same age, same 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, the window shades are open, she already put on a 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, what's going on, why such

“different outcome, and that's when you realize, I think pain is just, it's a mysterious”

thing. And some people respond very differently, and even the same person may respond differently at different times. 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 any 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

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 is a mental component, it ends up sounding to the patient like they're saying, you're making this up, or it's on your head, or you just need to relax when it's not quite as simple as that. The point you're hitting on, I think, has been one of the big challenges, but 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, have to listen to the patient and recognize”

that pain is, pain is pretty mysterious. Yeah, and be sort of humble, I think, about what we don't know. Yeah. Take away 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 Lim's 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. And if there isn't any. 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? What to pain researchers think is going on there? 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 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.

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. 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 they're used to be an injury. But now the tissue has healed, and this person still has severe or consistent pain, or it just comes back and it goes away. And then it comes back again.

Yes. Chrotic pain is pain that's occurring for at least three months. Okay. So they tried to put a timetable on it, but there are people who have pain for decades. So, you know, they can master really a 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 doesn't 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.

“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. Take away, too. Chronic pain is pain that's occurred for at least three months. Sometimes it happens after a known injury or trauma that tissue heals, but the pain remains. And other times there's no obvious cause.

Sanjay says there are still a lot of unanswered questions about why a pain turns from acute to chronic. I take one of the things that fascinated me just with regard to that chronicification of the pain, just the role of inflammation, for example, at the time of injury. Let's see, 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 I miss. It was these researchers who were trying to answer the question, who is more likely to

Like what demographic of people, 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, or the least likely to have chronic pain. So more inflammation at the time of injury, less likely to have chronic pain, almost the opposite of what everyone thought, what do 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, 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, well, here are more from Sanjay Gupta after the break, 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 earlobe, 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, it went from throbbing, like maybe add a 7 to a

2 or a 3, it felt like magic at the time.

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 Moore, 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, not everybody, to be clear.

But for the people who, from it was beneficial, it was extremely beneficial, while they were

actually undergoing the more 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, Maryel, 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 was in our control. Take away 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 they 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. 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 and habits your body. This is fascinating, I'm going to 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

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 opioids-sparing emergency rooms. 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 in fell broke his hip, very painful, did not want narcotics, and he already did not want

to give him narcotics. He got a nerve block, took about 10 minutes for the nerve block, he had 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. But you're going to tell me that you go be mindful, instead of taking a pill, it just wasn't how people were thinking in this country. 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 that there were

other really, really effective options moving forward. Take away four, there are other options for pain relief besides opioids, and in addition to the mental exercises we talked about, and pain killers, like NSAIDs and acetaminophen. It might be able to get a nerve block or 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 lie to cane patches. Some doctors treat their patients with low doses of catamine, which can provide rapid pain relief and be helpful when chronic pain flares. Also, their lifestyle habits that might improve your pain levels.

Regular movement, better sleep, an anti-inflammatory diet, and even connection. Having friends, having community. It's helpful to note 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?”

It's challenging. It is really challenging, and 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 they're frankly, they're everything. They're like these Swiss Army Knife, they're doctors, they're psychologists, they understand techniques, they know how to do nerve blocks.

Obviously, many of those things you can 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. Sanjay, thank you so much for this. It's been really nice to talk to you. I could talk about this all day, you know?

Same. All right, time for a recap. Take away 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. Take away 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.

Take away 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. And take away four. There are other options for pain relief, besides opioids, and alongside those mental exercises and pain killers like insides 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 light-cane patches. Some doctors give their patients low doses of catamine. 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.

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 F. Walter, 819, the subject line. Admitted, 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, F. Walter, 819. This episode of Life Kit was produced by Margaret Serino. Our digital editor is a molecule grieve, and Meghan Kane as our senior supervising editor. Beth Dottovan is our executive producer. Our production team also includes anti-tagal, clamouration writer, silvi Douglas, and

Jones and Barclay Walsh. I'm Mariel Sagarra. Thanks for listening.