CNN Chief Medical Correspondent Sanjay Gupta vividly remembers the day he impaled himself on a wrought iron fence. He had just turned 12, and he was running through the neighborhood when he spontaneously decided to vault over a fence that he usually ran around. Except he didn't quite make it.
"One of the spikes caught me on my side and went in the back area of my side and out the front," Gupta says. "It was the skin, thankfully, as opposed to going into the chest or into the abdomen, which would have been much worse, but it was sort of a classic in-out sort of injury."
Gupta says he was impaled for several minutes before his mother arrived to help hoist him off the fence. Looking back now, he remembers feeling a strange sense of euphoria when it happened, which he attributes to his body's natural pain relief system.
"For some people, it reacts really vigorously — like really, really churns out a bunch of endorphins," he says. "And so you could have this really sort of ironic situation where you've got a terrible injury and you're almost laughing. It's a very protective sort of response from the body. And not everyone responds the same way."
In his new book, It Doesn't Have to Hurt: Your Smart Guide to a Pain-Free Life, Gupta, a trained neurosurgeon, writes about pain — what causes it, and the various medications that can be used to treat it. He also reflects on ways to train the mind to minimize certain kinds of pain, using distraction and meditation.
"With pain, people are usually hyper-focused on a particular sensation. Being able to take them out of that hyper-focus can be really helpful," he says. "The idea [is] that you could take someone's pain score from really terrible pain to a zero out of 10 ... for the 30 minutes that they are meditating. ... I think the brain can be trained that way."
Interview highlights
On mistakes the brain makes in processing pain
One of the best examples of how the brain can make a mistake is phantom limb pain ... It was amputated, and yet it still hurts. I think that's one of those sort of insights about the brain that I think led to a lot of learning about what exactly the brain's role was with pain. If the brain's the decider of pain, can it create pain as well? And the answer is yes.
Referred pain is another sort of mistake. So some people may be having what should be chest pain from a heart attack, but instead of having chest pain, they may have jaw pain. They may have just left arm pain. ... And then there's sorts of things where whatever the reason may be, the brain continues to play the loop of pain over and over again. I guess that's not so much a mistake as it is maybe some sort of glitch, where the pain loop doesn't stop and it just gets recycled over and over again, and that's chronic pain. So those are some of the ways that the brain can sort of either mistake or misinterpret the signals and the pain.
On how pleasure can rewire brain
What I think is really interesting is that we have this system within our body, the endogenous opioid system. … This is like our internal morphine system, endorphin system. We can activate this system in all sorts of different ways. And by activating, I mean exactly what it sounds like. You just basically release a lot of these endorphins, these basically personalized morphine molecules all throughout your body. And one of the ways that they have shown can really facilitate that is to not just practice gratitude, but to actively practice gratitude. Meaning, actually savor something. I'm not just grateful for this ice cream cone. I'm so enjoying this ice-cream cone. I'm just not grateful for being able to look at this sunset. I am gazing at every different color in the sky and just taking it all in. It's a very active form of gratitude. And it seems to be very associated with basically activating the endogenous opioid system, which is really fascinating to me.
On opioid drugs compared to the body's natural opioid system
So many techniques and medications that we use in real life take their inspiration from our human body, and that's one of them. … With your own opioid system, it is very, very sensitive. So it can turn on and it can turn off really, really well. So instead of having the lingering sort of side effects of opioids and sedation and all these other things, the opioids that you make yourself can just be washed away very, very quickly. …
I always say if the endogenous opioid system didn't exist, women would probably never have more than one child. It can be a painful experience, but those [natural] opioids help with the pain. They help with the mood, and … [they] can actually inhibit your memory.
On how inflammation serves a purpose
I think for the most part, inflammation has sort of gotten a bad rap. ... I think when you look at a sprained ankle, for example, and it looks swollen and red, the idea that I want to get rid of that. That's associated with my pain makes intuitive sense. I think the idea that that inflammation serves a real purpose, that not only is it sort of helping protect the site of injury, but also sending all these various molecules to the site of injury to help with the healing. ...
The thing about pain is that everyone's threshold is going to be a little bit different. … I think for a lot of people, they think they need to take anti-inflammatories. Oh, this is bad, I gotta treat that, that inflammation's not good, that's hurting my body. But if I flip the script on you and I say, "It's not bad for your body, that is exactly how your body is supposed to work. This is your body doing its job."
On a new FDA approved non-opioid pain medication
The medication is called Suzetrigine. … It is a fascinating story of how it came about. There were these families of circus performers in Karachi, Pakistan. That got the attention of researchers, whatever, 25, 30 years ago. And they saw that these circus performers were able to do all these remarkable things, like they could put sharp things through their appendages and they could walk on hot coals and do all that sort of stuff. But what they found was that when they were doing this, they could feel the coals on their feet and they could feel that they were hot, they just didn't have pain. … And that was pretty striking because it gave these researchers a clue as to which sodium channel blocker may be important when it came to just targeting pain and not sensation overall. They studied this family. They found that they had a gene in common. ... And basically for 25 years, these researchers tried to replicate what that gene was doing in the body. ... Now, one of the big challenges of creating a medicine like that is you didn't want to take away pain forever. Pain has utility. It can keep you safe. It can teach you lessons. So they wanted to create a half-life for the drug. So they basically now have an oral formulation.
On Cannabis for pain
I walked into it thinking that if I really examined all this literature, there was going to be a pretty compelling case made for using cannabis for all sorts of different pains … and I walked away not as impressed, to be quite honest, as I thought I would be. And this is just the data talking. I will say it's hard to collect this data when you're dealing with a substance that has been a level one substance in the United States for a long time. It's just really hard to get good studies. …
But having said that, the best available data seem to suggest that for about a third of the people, it could be pretty effective, and maybe in some cases as effective as the best other options for that neuropathic pain. … For about two-thirds of people, it really did not seem to be that effective. And this is the case, I think, for about a third of people, they get significant benefit. And we don't quite know who those third of the people are. We don't know what makes them different than the other two-thirds that they're getting that kind of relief.
Monique Nazareth and Susan Nyakundi produced and edited this interview for broadcast. Bridget Bentz and Molly Seavy-Nesper adapted it for the web.
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