Return to Transcripts main page
CNN Special Reports
Dr. Sanjay Gupta Reports: "It Doesn't Have To Hurt". Aired 9- 10p ET
Aired September 07, 2025 - 21:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[21:00:00]
DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: I mean, what we're learning about pain, and I think we're going to look at other ways to sort of change the brain to decrease how severe pain is and how long it lasts, not through brain surgery, but other modalities over time.
So that's one of the points I really wanted to get across, Jessica, all pain lies in the brain. The brain decides if you have pain or you don't have pain. And I think that's an opportunity and hopefully a source of inspiration for a lot of people -- Jessica.
JESSICA DEAN, CNN HOST: Indeed. Thanks so much.
DR. SANJAY GUPTA REPORTS: "IT DOESN'T HAVE TO HURT" airs next here on CNN.
And thank you for joining us tonight. I'm Jessica Dean. We'll see you right back here next weekend.
GUPTA: We're already giving an idea of just how busy this hospital is.
(voice-over): I'm a trauma neurosurgeon. After decades of treating people in pain, people all around the world --
Give you an idea of just how challenging --
I thought I truly understood pain and the life-changing toll it takes. That is, until now.
I'm Dr. Sanjay Gupta. IT DOESN'T HAVE TO HURT.
Have you ever been in pain? I guess it's sort of a silly question because, who hasn't? In fact, nearly 21 percent of the U.S. population, more than 51 million adults, they deal with pain all the time. It's pain that simply does not go away. And 17 million of those people are in so much pain that it restricts their life.
As a doctor, I treat people in pain every day. But over the years, my understanding of pain, the role that it plays in our lives, and the exciting new ways to treat it have transformed me into who I am as a doctor, as well as a person.
What you're about to learn in this hour could change how you treat and manage your own pain, from everyday headaches to life-changing injuries.
(MUSIC)
GUPTA: I'll never forget that day in April 2023 -- pain, terrible pain, visited my own family. And everything I thought I knew changed.
DAMYANTI GUPTA, DR. GUPTA'S MOTHER: I never experienced that kind of pain in my life.
GUPTA: Meet my mom, Damyanti Gupta.
If you had to rate it on a scale of 1 to 10, where did it fall?
D. GUPTA: Out of 10, it was, like, 80.
GUPTA: Like 80.
D. GUPTA: Eighty.
GUPTA: Do you remember what you said to me?
D. GUPTA: What?
GUPTA: You talked about the fact that, if this pain didn't go away, you didn't think you wanted to live anymore.
D. GUPTA: I could not even stand on my two feet. I could not brush my teeth. I could not change my clothes. I could not comb my hair.
GUPTA: I remember that your stomach sort of dropping a bit, because you're like, well, she doesn't complain about anything. If she's complaining about this, this has got to be bad, whatever it is.
(MUSIC)
GUPTA: You have to understand, my mom is always on the go, always chasing life.
All right, I've never done this before. So here we go.
(MUSIC)
GUPTA: She grew up in refugee camps after the bloody partition of India but still went on to become the first woman automotive engineer at Ford Motor Company. She's a pioneer, a glass-ceiling breaker. She wears adversity like a badge of honor, a source of pride.
But then pain -- this pain at 81 years old from a simple fall right outside her apartment.
SUBHASH GUPTA, DR. GUPTA'S FATHER: I did not know what was going on. I just put her in the bed.
GUPTA: This is my dad, Subhash Gupta. They've been together for nearly 60 years.
Had you ever seen her in this sort of pain before?
S. GUPTA: No, never.
GUPTA: What is the partner to do in a situation like this, when your loved one is in that kind of pain?
S. GUPTA: Helpless. You try to do the best you can.
D. GUPTA: Something was not right.
GUPTA: The first thing to know about pain is that, as difficult as it is, it usually serves some sort of purpose, teaches you a lesson. Like, touch a hot stove -- you do that once, you're probably never going to do it again. It can also be your body's warning system, communicating to the brain that there's a problem that needs attention. That was certainly the case for my mom, telling her it was time to get help.
DR. JEFFREY HENN, NEUROSURGEON: Dr. Jeffrey Henn: welcome to Fort Myers.
GUPTA: Thank you very much, great to be here.
HENN: Thank you.
GUPTA: I want to say thank you, first of all, for taking care of my mom.
HENN: Of course.
GUPTA: This is Dr. Jeffrey Henn, my mom's doctor. He's a fellow neurosurgeon, like me.
HENN: This was the problem right there at l1. But I was very concerned. That's maybe 80 percent collapsed. And then it was, part of the bone was actually sticking backwards into the space that's supposed to belong to her spinal cord.
GUPTA: Mom broke her back when she fell. And now her spine was literally collapsing.
HENN: I think, as an analogy, imagine if you had a broken arm, and it wasn't in a cast. Every time you move, the bones would kind of crunch on each other. I mean, we can all imagine that's got to be horrifying.
[21:05:01]
GUPTA: Dr. Henn wanted to move fast, not just because of the spinal collapse, but also because of the pain. In fact, he called it a pain emergency.
HENN: I think, as a compassionate human being, it's hard to sit by and watch somebody suffer.
GUPTA: Dr. Henn recommended a procedure called a kyphoplasty. Here's how it works: a hollow-bore needle is inserted directly into the broken vertebra. And then a balloon is blown up to sort of realign the broken bone. Then with a dollop of cement, the bone is stabilized.
Think of it as an internal cast for the broken bone. While it is a quick, minimally-invasive procedure with light sedation, any surgical procedure for someone in their 80s is risky.
HENN: You can become paralyzed by the risks of what if.
S. GUPTA: I remember you telling me, you were not sure if -- should we wait?
GUPTA: I've had to make many tough calls as a neurosurgeon. But in some ways, this was probably the toughest. After all, this was my mom.
With no surgery, the worst-case scenario, possible paralysis, and likely a lifetime of powerful medications, something I know she didn't want.
And then, of course, there was the pain itself. My mom was in acute pain, sharp and severe, which usually only subsides once the source heals. But if left untreated, it could become chronic pain, refusing to go away.
How much of your life was sort of consumed by pain at this point?
D. GUPTA: Totally.
GUPTA: It's your whole identity.
D. GUPTA: At that time, yes.
GUPTA: What if there was no option, surgical option? What would you have done?
D. GUPTA: I don't think I had even the courage to think about it.
HENN: This is where we did your mom's kyphoplasty. So she was here?
GUPTA: Yeah.
Five days after her fall, my mom was wheeled into this operating room.
HENN: Number 1, we didn't have any complications. Number 2, we accomplished a lot of things that I was hoping to accomplish.
GUPTA: Did you notice that your pain had changed?
D. GUPTA: Yeah, right away. At least, I could stand up now without pain.
GUPTA: It was 80 out of 10 --
D. GUPTA: Back to maybe 5, 6, maybe even less.
GUPTA: As the inflammation that accompanies any injury subsided, so did the pain. A week later, she was down to a 3.
D. GUPTA: That was a blessing to have a 3. Yes.
GUPTA: To go from 80 to 3. Yeah.
D. GUPTA: Yeah.
GUPTA: But it got better than that, even.
D. GUPTA: Yeah, my strength is coming back.
GUPTA: And you never really have pain.
D. GUPTA: No.
GUPTA: More than a year later, she still has some soreness in the mornings.
Does the walking help with your pain?
D. GUPTA: You know, I think so.
I'm blessed that things have gotten better.
GUPTA: What did you learn from all this, in terms of pain?
D. GUPTA: You know, things are going to happen in the life. How you handle is important at that time.
(MUSIC)
GUPTA: For my mom, she fell. And we thought it was a trajectory towards terrible things. But she was able to bounce back from that. And she was able to take her pain score from "I want to die" to a 2 or 3 out of 10. That's a pretty remarkable thing.
I saw what happened to my mom. And I think it's deeply inspiring.
(MUSIC)
GUPTA: Now, you will soon learn that my mom was actually one of the lucky ones. The source of her pain was clear, and it was treatable. But for millions of people, that's not the case.
BLAKE HARDWICH, MIGRAINE PATIENT: I'm almost ready to throw in the towel.
GUPTA: Chronic pain and a pain detective, when we come back.
But first, some pain points. How to best describe your pain to your doctor? First, close your eyes, and really identify your pain. How does it feel, hot, cold, tingling? Use your best adjectives.
When does it appear, morning, nights? Is it better when you move, or is it worse? Where is it exactly? Can you point to it with one finger? What makes it better or worse?
Answering these questions can make all the difference when best describing your pain and getting relief.
(COMMERCIAL BREAK)
[21:11:35]
GUPTA: So, here's the thing about pain. Sometimes, like with my mom, there is a clear cause. She broke her back. The doctors knew it. And they could treat it.
But for many, there is pain, chronic, debilitating pain, that seems to have no root cause, migraines, irritable bowel syndrome, fibromyalgia. It's often a mystery.
So, putting together the pieces of the pain puzzle is not that easy.
(voice-over): Fairhope, Alabama, the beautiful eastern shoreline of Mobile Bay. It's quiet here and peaceful.
It was a peace that resident Blake Hardwich was so desperate to find but never could.
HARDWICH: I remember being in the ER and just holding my head as hard as I can, tears coming down my face. I kept saying, it feels like I've had a cement block sitting on top of my head.
GUPTA: Blake suffered with chronic pain from migraines for more than 20 years.
How long would they last?
HARDWICH: At the beginning, one to two days.
GUPTA: And that time period, you were basically not able to function?
HARDWICH: Yeah. And I was trying to get in the darkest room, no light.
GUPTA: Her first migraine hit in law school decades ago. And then she only got them occasionally. But after she had her children, Blake suffered from debilitating migraines every single day.
HARDWICH: As a mother, when I would have these migraines, I felt so guilty. You know, I've got twins, two years old, running up and down hardwood floors, screaming, giggling. And it was killing me, like, I didn't want to hear it. And I thought, how bad, as a mother, not to want to hear the laughter and, you know --
GUPTA: Right.
HARDWICH: -- pattering of feet.
GUPTA: Blake saw many neurologists and other specialists over the years. But no one could figure out the root cause of her chronic pain. She got medications, but they provided little relief and lots of side effects.
She would be woozy, dizzy, foggy, and forgetful. HARDWICH: I did think I was going crazy at that time. Some of the
times when I go to the ER visits, I was kind of written off as a nutcase.
DR. JOEL SAPER, NEUROLOGIST: Well, that doesn't surprise me at all because there has always been, in the health care fields, discriminatory behavior, whether it's toward women or toward Black people.
GUPTA: Dr. Joel Saper is a pain pioneer, a renowned neurologist and a headache specialist.
SAPER: Hey, Sanjay.
GUPTA: How are you, sir?
SAPER: I'm doing fine.
GUPTA: It has been too long.
SAPER: It's been a long time.
GUPTA: I've known him for years.
SAPER: I had one very important neurology professor who, one day, came to me and said, Joel, why are you going to waste a brilliant career in neurology to treat those crazy headache patients?
GUPTA: Wow.
SAPER: That was the prevailing attitude. If you were a woman and you had headaches, well, then you must be a neurotic, or anxious, or depressed. It wasn't taken seriously.
(MUSIC)
GUPTA: And that makes diagnosing and treating the pain difficult, if not nearly impossible, as it was for Blake.
That is, until, after two decades of pain, she was finally given Dr. Saper's number.
[21:15:03]
I've known him for a long time. And I think part of why I send him so many patients and-- he was a little bit of a Sherlock Holmesian kind of guy.
HARDWICH: I totally agree with the fact that he knew more about me than I thought he would. I felt validated that, you know, he under -- he understands what I'm going through. He gets me.
GUPTA: It was November 2023, Saper and his team admitted Blake to the hospital for several days, and they ran a series of tests. Together, Blake and Dr. Saper became pain detectives. They were digging through her history in a way no one had before. And finally, a clue, a high school memory, something that happened 30
years ago at cheerleading practice.
HARDWICH: We were practicing for national competition. I fall, and then I feel her fall on my back of my head, which slung my head forward. And I could not move. I was slumped over.
GUPTA: Blake then spent a week in the hospital with a spine fracture, and she wore a brace for months afterward. The break did eventually heal.
Was that a sort of aha moment for you?
SAPER: We have learned from experience that the trauma can occur years before its manifestations. So, when she said that she fell from the top of a pyramid and then someone fell on her, that mattered. It's like nature put your headache boulder on the ledge of a cliff.
And all these different things just keep nudging it until it finally goes over the cliff.
GUPTA: For Blake, who Saper learned already had a family history of migraines, that fall in high school had pushed her migraine boulder over the cliff.
So, Saper decided to zero in on her neck to help treat her head.
No one was connecting the dots between that significant fracture and the migraines now.
HARDWICH: I was.
GUPTA: You were?
HARDWICH: Because I kept saying, I had a bad fall. You might want to check my neck.
They would do a cat scan, but nothing would show up.
GUPTA: You're probably wondering, if there is no identifiable injury or if it's seemingly healed, then why is there still pain associated with it? Well, remember what I told you about acute pain. It can evolve into chronic pain. And that's because the brain may take a routine, acute pain experience -- in Blake's case, it was that fall -- and it can then prolong it to chronic pain.
Think of it as an experience or a memory that just keeps getting played over and over again, kind of on an endless loop. For reasons not yet fully understood, the brain remembers the pain long after the physical damage is healed.
SAPER: Acute pain can evolve into chronic pain because as you know, Sanjay, the circuits in the brain interact with each other.
GUPTA: So, Saper tried to short circuit for Blake, first with spinal epidurals every few months and then a combination of physical therapy and a fine-tuned regimen of medications. And it worked.
HARDWICH: After I got back from treating with Dr. Saper, I came back, and I was, like, ready to go. And my husband said, whoa, whoa, whoa. I'm not used to this Blake. We're going to have to learn to get used to this Blake.
GUPTA: What message do you want to give the tens of millions of people out there who are suffering with chronic pain?
SAPER: Not to give up. There may be no treatment available today. But that doesn't mean they shouldn't try.
HARDWICH: Do your homework. Find you a doctor that will really listen to you. You've got to have doctors that are willing to take the time, that are willing to hear the patient and try to get to the root cause.
DR. PRASAD SHIRVALKAR, PRINCIPAL INVESTIGATOR, UCSF PAIN NEUROMODULATION LAB: Based on what we know.
GUPTA: When we come back, a trip to the root of all pain.
ED MOWERY, DEEP BRAIN STIMULATION PATIENT: The pain's gone. The pain's done.
SHIRVALKAR: You're not kidding me?
MOWERY: I'm not kidding.
GUPTA: But first, some pain points.
What's the best way to treat headaches and migraines? Many things can contribute to a headache -- dehydration, tension, sinus issues, elevated blood pressure, stress, even certain medications. Figuring that out can be a challenge but important to do, because most of those causes can be addressed and many without medications. One way to start, keep a headache journal for a couple of weeks. That could provide a lot of insights toward figuring out what is causing the pain.
(COMMERCIAL BREAK)
[21:24:41]
GUPTA: You know the expression, "It's all in your head"? Well, actually, with pain, it absolutely is.
The brain is your pain center, not the place where you actually injure yourself, your stubbed toe, broken wrist, or pulled muscle. Pain is created when signals travel from the point of injury to the brain.
[21:25:00]
And then your brain reacts with sensation of pain. It's why everyone reacts so differently to pain, because everyone's brain is unique. Two people with identical injuries on an X-ray could have completely different perceptions of pain. And it's that subjectivity that makes pain, especially chronic pain, so hard to treat.
(MUSIC)
GUPTA: I'm about to take you on a trip inside the brain, 3-1/2 pounds of the most mysterious tissue in the known universe, with more connections than stars in the sky.
And hidden in that big galaxy of stars are the connections that create pain.
SHIRVALKAR: It's mind boggling, right? More than a needle in a haystack.
GUPTA: Dr. Prasad Shirvalkar will be our guide. He's a neurologist, a pain doctor, a trailblazer. And he is searching for the mystery of pain inside the brain.
SHIRVALKAR: So, for the longest time, pain was called the fifth vital sign, right? But unlike the other four vital signs, there's no objective measure, right? It's not like temperature or heart rate.
So, one of the holy grails of pain medicine has been coming up with a biomarker for measuring how intense or how severe somebody's pain is. This is exactly an example of a device that --
GUPTA: So, Shirvalkar has made this his life's work and has an audacious plan to try and measure pain. To start, surgery, to stick multiple probes all over the brain.
SHIRVALKAR: It's this device kind of -- it goes above under the scalp and connects to one of the wires going into the brain.
GUPTA: Scientists then simply listen to the billions of neurons in the brain and see what areas fire up when the patients have pain.
SHIRVALKAR: And we're targeting key areas.
GUPTA: I told you, it's audacious, about as cutting edge as it gets.
SHIRVALKAR: So telling someone you're going to drill holes in their skull, it should raise concern.
GUPTA: So they tell you all this, and your first reaction is what?
MOWERY: I hung the phone up.
(LAUGHTER)
GUPTA: Click.
MOWERY: Yeah, no way, ain't happening.
GUPTA: After being a real daredevil in his early years, 54-year-old Ed Mowery had collected a lifetime of injuries and a lifetime of pain.
Thirty-four surgeries. MOWERY: Mm-hmm.
GUPTA: Wow.
MOWERY: Eleven knee surgeries and my right knee replaced. I've had C3 to T1, L4 to S1, all fused, all new disks.
GUPTA: Initially, Ed would heal, and the pain would subside. But then, starting in 2009, after knee surgery, a relentless pain developed like he had never felt before.
MOWERY: Unbelievable burning, just nonstop -- think about the worst burn you've ever had in your life, and multiply it by 10 or 20. And then it never, ever stops.
Yeah, you know, it feels like someone's cutting the bottom of your feet. It was quite painful. I would say it's more than painful.
GUPTA: It took 10 years and lots of doctors for Ed to be diagnosed with complex regional pain syndrome, or CRPS. It usually occurs after an injury or an operation. And while it can occur anywhere in the body, it usually affects the hands or feet.
So, in a sense, maybe, it was the surgeries. But it seemed to have started you on the cycle of pain.
MOWERY: Yeah.
GUPTA: Now you might wonder-- and so did I -- if the surgery that kicked off Ed's chronic pain was in his knee, then why was the pain now so profound in his feet?
Well, the best way to think about this may be like the phantom pain of an amputee. That's pain in a limb that no longer even exists. After all, Ed had no cuts or bruises, no visible injuries. This pain was being completely manufactured in his brain.
MOWERY: Manufactured pain from the brain with no stimulus, it's unreal.
GUPTA: So that's just your brain creating the pain.
MOWERY: Yes. The Lyrica and the morphine will be first.
GUPTA: He did try a very long list of pain pills.
MOWERY: And these are all the ones that I was on.
GUPTA: Oh, my God. So, Hydrocodone, Norco, Celebrex, Vicodin, Percocet, Oxycodone, Dilaudid, Demerol, Tramadol, Temazepam, Gabapentin, Methocarbamol, Baclofen, Valium, Flexeril. I don't even know this one. Do you ever have zero pain, even when you were on these meds?
MOWERY: No.
GUPTA: Eventually, he had enough and was willing to do anything, even brain surgery.
MOWERY: I thought, you know, let them do whatever they got to do just to get me out of pain.
GUPTA: In the fall of 2024, Ed had electrodes implanted deep into his brain.
SHIRVALKAR: You're seeing here Ed's brain. And all of these little colors represent probes.
GUPTA: And there are as many neurons in your brain, if not more, than there are stars in the sky.
MOWERY: Yeah, exactly.
GUPTA: It's like throwing a telescope up at the sky and just seeing what you see or hearing what you hear.
MOWERY: Yeah.
GUPTA: It's quite a daunting task.
SHIRVALKAR: We're actually recording activity from each one of those 140 contacts to try to identify where to stimulate but identify what is the signal, the biomarker, that tracks his pain.
[21:30:11]
GUPTA: And for the first time ever, they obtained a real-time pain map.
What you're looking at is Ed's brain in pain. And then they pass an electrical current into Ed's pain centers.
And watch what happened.
MOWERY: Both dropped to zero.
SHIRVALKAR: To zero?
MOWERY: Yeah.
SHIRVALKAR: You don't feel pain at all?
MOWERY: I don't feel nothing. I feel my feet. Yeah, like I can. But yeah, the pain's gone. The pain's done.
SHIRVALKAR: You're not kidding me?
MOWERY: I'm not kidding.
SHIRVALKAR: I believe you.
MOWERY: I'm not kidding. I'm not kidding. It dropped. I mean, it's barely looking at a 1 on both of them.
SHIRVALKAR: That's incredible.
MOWERY: It was like a veil lifting. It was like a ton of bricks falling off your shoulders. It was, all at once -- all that, all at once. And it was euphoric.
GUPTA: But that was the first time in a long time, Ed, that you had not been in pain.
MOWERY: Mm-hmm. Yeah. It's like the best drug I ever did, and I didn't do any drugs.
(LAUGHTER)
SHIRVALKAR: Yes. We were not expecting that, at all. It surprised me how quickly he responded. You hit a particular spot, and it changes their life.
MOWERY: I'm able to tell you exactly the number of my pain.
GUPTA: I visited Ed in his hometown of Albuquerque, New Mexico, to see just how much it had changed his life -- walking, exercising, just enjoying time out with friends, and also traveling the world with his music.
SHIRVALKAR: Hey, buddy.
MOWERY: Hey, what's up, you guys?
GUPTA: He continues to meet with Shirvalkar's team to monitor his implants remotely, checking in from New Mexico.
SHIRVALKAR: All right, there you go.
UNIDENTIFIED FEMALE: Nice, look at that. We're in here.
GUPTA: Since the brain is a dynamic organ, they are always tweaking the settings. He even felt it turn on during our interview.
MOWERY: I can feel the pain go --
GUPTA: Wow.
MOWERY: Yeah.
GUPTA: I got to say, because I've been a neurosurgeon for a long, long time, I haven't heard that level of description before.
MOWERY: Yeah.
GUPTA: That's pretty wild.
MOWERY: Yeah, I think it's pretty much what makes me one of the first cyborgs in the United States.
(LAUGHTER)
MOWERY: It's 100 percent changed my life.
SHIRVALKAR: Ed is a pioneer. Ed is, one, to help himself, but really to help humanity, to make this world better. And that's just -- it's priceless to me.
MOWERY: I feel like I owe him my life.
GUPTA: Invasive brain surgery for pain -- obviously, this won't be an answer for the masses. But look at what we have learned. Pain lies in the brain. It is measurable. It is predictable and preventable.
SHIRVALKAR: There's hope. A lot of scientists are tirelessly working around the world to try to make your life better in the next five to 10 years.
GUPTA: OK, five to 10 years. We'll come back and check in.
SHIRVALKAR: All right.
GUPTA: That's the future. But coming up, what doctors are offering today to treat your pain.
UNIDENTIFIED MALE: So hopefully, this will give you enough pain relief.
GUPTA: An alternative to opioids, when we come back.
But first, some pain points. How to find the best doctor for your pain? There are so many doctors who treat pain. Besides your primary care doctor, there are neurologists for brain and spine-related pain, orthopedics for bones and rheumatologists for joint pain.
One thing to keep in mind, though, chronic pain hardly ever occurs in isolation. It always comes with baggage attached -- depression, anxiety, poor sleep. Sometimes the pain worsens those things, and sometimes those things worsen the pain. But here's the point. Addressing the baggage is as important as addressing the pain itself. You need both.
(COMMERCIAL BREAK)
[21:38:42]
GUPTA: If you've read anything about pain over the past 20 years, you've likely been angered by the opioid epidemic. During the worst years of the crisis, doctors routinely used opioids for just about any kind of pain, from dislocated hips to toothaches. Opioids were promoted as wonder drugs. And the number of opioid prescriptions in the United States continued to rise until around 2011, as did death tolls and overdoses.
Now, because opioids consume so much of the conversation, most people don't even realize, there are plenty of other effective options to help relieve pain.
(SIREN BLARING) GUPTA: This is the ER at Maimonides, Brooklyn's largest hospital. It looks and sounds like a typical level 1 trauma center.
UNIDENTIFIED MALE: Can we also repeat a CBC?
GUPTA: But as you'll soon learn, there's something very unique and groundbreaking happening here.
DR. LUKE WEBER, MAIMONIDES MEDICAL CENTER: Sounds good.
GUPTA: Dr. Luke Weber and his team of residents are about to start the afternoon shift.
WEBER: What we're actually going to see, very unpredictable. We got to be ready for anything.
GUPTA: Chest pain, car accidents, gunshot wounds --
WEBER: You got it.
GUPTA: -- stabbings.
WEBER: Anything that comes through, we're ready for.
[21:40:01]
GUPTA: He estimates that 70 percent to 80 percent of the people who will come here today will do so because of pain.
Is opioids still the therapy of choice?
WEBER: Opioids is one of our therapies. But we take a lot of pride here in offering a wide variety of pain modalities.
GUPTA: It's called opioid optimization. And it's pioneering work designed by this man ---
DR. SERGEY MOTOV, EMERGENCY MEDICINE PHYSICIAN: Did you fall at all?
UNIDENTIFIED FEMALE: No.
GUPTA: -- Dr. Sergey Motov, an emergency medicine physician and research director at Maimonides.
MOTOV: We decided to use non-opioid analgesia as a primary analgesic of choice. Obviously, after patient's agreement -- and resort to opioids only as a rescue.
GUPTA: That's right, opioids as the last resort for pain, instead of the first. It's standard operating procedure here now. And they have found, most of their patients are quite satisfied.
An option that you would use instead of an opioid, what would be an example?
WEBER: We're starting to do more and more nerve blocks in the ER. It's quick, easy, and it works for hours and hours.
GUPTA: This might sound familiar, injecting local anesthetic at the site of an injury to block the nerves from feeling pain in that area. It's like an epidural during childbirth. But using these nerve blocks in the emergency room, that's cutting edge.
UNIDENTIFIED MALE: I'm just going to lower your bed a little bit, okay?
GUPTA: Here, they actually have a whole nerve block team at the ready. This is 76-year-old Joseph. Today, he's being treated for a broken hip. In most ERs around the country, you can bet he would have been given opioids.
JOSEPH TANCREDI, NERVE BLOCK PATIENT: I do not take drugs. I took drugs in the '60s -- no more.
UNIDENTIFIED MALE: You're going to feel a slight poke.
GUPTA: The procedure took less than 10 minutes.
UNIDENTIFIED MALE: So hopefully, this will give you enough pain relief so we don't have to use any other type of pain medicine like opiates. How are you doing?
GUPTA: And Joseph felt pain relief almost instantly.
TANCREDI: Good, no pain.
GUPTA: That's kind of incredible. Because I think the knee-jerk response -- you get somebody who comes in with a fracture, probably getting opioids. At least, that's what I heard.
WEBER: You're absolutely right. That's a common knee-jerk reaction in the ER, unfortunately. But places like this, we're really trying to change that paradigm.
GUPTA: Another step toward changing the paradigm, educating doctors --
MOTOV: Any question?
GUPTA: -- even before they become doctors.
MOTOV: How many of you believe that pain is properly treated in the emergency department? Most of you.
GUPTA: For the past five years, Motov has given pain talks once a month to medical students. And I was surprised to learn that, for some of these medical students in attendance, they had spent just a few hours on pain management during all four years of med school.
GUPTA: Was there something that you took away from today's lecture that would change how you think about opioids?
IVANA BALDIE, FOURTH-YEAR MEDICAL STUDENT: How it's going to affect that patient when they walk away. And how much responsibility am I willing to take on if I do choose to prescribe an opiate?
MOTOV: So just put in perspective in the numbers.
GUPTA: These students are being taught non-opioid options early on.
MOTOV: So ibuprofen, naproxen. We do talk about acetaminophen.
GUPTA: Tylenol.
MOTOV: Tylenol, exactly.
GUPTA: When used intravenously, Tylenol can help supplement other medications to help manage moderate to severe pain.
And a new, non-opioid pain medication, Suzetrigine, marketed as Journavx, was just approved by the FDA earlier this year.
MOTOV: Incredible breakthrough. It was sort of long overdue. It's the first new drug that has viable analgesic efficacy over the past 20 to 25 years.
GUPTA: It is shocking, actually. It's the first new pain medication approved in 25 years. I mean, Celebrex was the last one. And that was 1998.
And just to give you some context, the FDA approves around 40 to 50 new drugs a year. And yet, as common as pain is, there were no new drugs for a long time.
It's amazing to me, as you saw, new medications developed for heart disease, and diabetes, and cancer, and immunotherapies. The fastest growing condition in the United States, chronic pain, had nothing new to offer these patients in terms of medications.
SHIRVALKAR: For so long, there's been a bit of a monopoly from the opiate manufacturers on marketing and pain. And so, the money wasn't flowing elsewhere.
GUPTA: Opioids sort of sucked all the oxygen up in the room.
SHIRVALKAR: That's a good way to put it, yeah.
MOTOV: We've been so focused on this battle against opioids that we've been sort of repurposing rather than exploring new drugs at much greater extent.
GUPTA: One drug, they're successfully repurposing, ketamine. It works by temporarily blocking a special receptor called NMDA, which is associated with pain. It really seemed to work for 55-year-old, Dan Kruger.
[21:45:03]
An international motorbike racing champion, Dan has had a lot of injuries. DAN KRUGER, INTERNATIONAL MOTORBIKE RACING CHAMPION: I've broken toes
a number of times, both my feet and both my ankles. I broke five ribs at the same time I broke the collarbone two years ago.
GUPTA: With all those injuries came pain. And with pain came opioids.
KRUGER: I was a functioning addict. I was planning my days around it. My priorities started with, how many pills will I need today?
GUPTA: After an overdose nearly killed him, Dan knew he had to quit, not racing, but the drugs.
KRUGER: The challenge was, I still raced motorcycles. So, I still get injured.
GUPTA: After a particularly gruesome crash three years ago in Atlanta, Dan woke up from emergency surgery with one request.
KRUGER: The very first thing I said to the doctor -- and there was no opioids. So they just started giving me ketamine shots to help with my pain. It was amazing, because the pain would go away immediately, like instantly.
GUPTA: And there was something else Dan also used that accomplished nearly the same thing.
KRUGER: That's unbelievable.
UNIDENTIFIED MALE: Great job, man.
KRUGER: Wow.
GUPTA: That when we come back.
Now, let's get to some pain points. Are supplements good for pain? The truth is, there isn't a lot of great data on supplements for pain. But a few that doctors sometimes recommend -- magnesium for back pain. COQ10, that can help with pain after intense activity. Turmeric can be a potent anti-inflammatory. And willow bark, which has the same active ingredient as aspirin.
Always check with your doctor first. And importantly, buy from a reputable source so you're getting a safe product.
(COMMERCIAL BREAK)
[21:51:23]
GUPTA: Take a minute. And think about the last time you were in pain. Maybe it was a stubbed toe, or a headache, or maybe something more serious. It can really take over your life and your thoughts. You start to anticipate it, and think about it, and worry about how bad it's going to get.
You wonder if the pain will ever stop. You can't really think about anything else. And it made me wonder if there was a way to break that thought cycle and almost think or will the pain away. It turns out, there is.
GUPTA (voice-over): July 2025, race day for motorcycle champion, Dan Kruger.
A hundred fifty-five laps, 170 miles an hour, 101 degrees. Halfway through the four-hour race, Dan is in pain.
KRUGER: It's rough. I'm not going to lie. It's really challenging out there.
GUPTA: But the speed, the power, the thrill, it all drives him. It's addictive.
Almost as addictive as all the opioids that got him through the pain in the first place.
KRUGER: A lot of oxys.
GUPTA: What is it like for you to look at all these pill bottles?
KRUGER: I really just kind of knew that I had a task. I had to get off them, and move forward.
DR. ERIC GARLAND, PSYCHIATRY PROFESSOR: You're strengthening mindfulness.
GUPTA: Something he was able to do with a new treatment that he does before every race, meditation. A new take on a centuries-old practice, it is now part of his daily life.
GARLAND: Turning your attention inward.
GUPTA: We even decided to try it during a break from our interview at his lakefront home in Georgia.
KRUGER: As soon as I'm sitting down, meditating, I know I'm in for a good 15 minutes --
GUPTA: Of pain free --
KRUGER: Pain free.
GARLAND: Turn the focus of the attention back to the breath.
GUPTA: Now, that quiet, peaceful voice guiding his meditation is Dr. Eric Garland, a professor of psychiatry at the University of California, San Diego.
GARLAND: I've turned to mindfulness as a potential treatment for pain, because mindfulness is all about bringing attention into the present moment.
GUPTA: For years, Garland worked with primary care physicians and their patients who reported pain. And he used powerful mindfulness techniques, like meditation and behavioral therapy, to try and treat their pain. Three years ago, when Dan was looking for treatment options, he
stumbled onto Garland's work.
GARLAND: Turning your attention inward.
KRUGER: The very first time we did the guided meditation, all my lower-back pain, all my SI pain, all my aches and pains, my headaches, gone. The entire 20 minutes we'd meditate, gone, like, 100 percent gone. I knew that I wouldn't take another opioid.
GARLAND: Look at the screen. And focus on the image.
GUPTA: Six months of working with Garland, and Dan was weaned off the opioids completely.
GARLAND: When they learn the technique, people can get, on average, about that 25 percent or 30 percent reduction in pain immediately after 15 minutes of mindfulness.
GUPTA: Wow.
GARLAND: Now, that's just an average, right? So, some patients can experience even more pain relief from mindfulness.
GUPTA: The NIH and other government agencies have funded Garland's research.
[21:55:02]
And the results have been impressive.
GARLAND: We've studied the mindfulness meditation practices and find that, on average, they reduce pain by about 25 percent or 30 percent in the moment. And that's about as much pain relief as you would achieve from 5 milligrams of oxycontin.
GUPTA: I want you to really take that in -- meditation, mindfulness, potentially as good, if not better, for some than opioids and without the risks and the high abuse potential those drugs have.
It's about as low-tech as you can get. And you can really do it anywhere.
The success stats are hard to believe. So, I went to Dr. Garland's lab to put it to the test.
GARLAND: This is a device for delivering heat stimulation to your arm. And so, it's going to deliver five 10-second-long pulses at 48 degrees Celsius, which is about 119 degrees.
GUPTA: OK.
GARLAND: And so you're going to experience it. And then I'm going to ask you to rate your pain.
OK, here we go. GUPTA: So that first round, five powerful bursts of extreme heat on my
arm. I got to say, it was pretty intense and pretty unpleasant.
GARLAND: So when you're ready, you can allow your eyes to close.
GUPTA: And then Garland just talked me through some basic meditation techniques.
GARLAND: Back to the sensation of the breath. Ready to try the heat again?
GUPTA: Yeah, let's do it.
And then I was ready for another round of 119-degree pulses on my arm. This time, I was just meditating the whole time.
GARLAND: And just letting that sensation go.
GUPTA: And then, the results -- he had measured my intensity and unpleasantness scores.
GARLAND: You went from a 7.4 in pain intensity to a 3.7 in pain intensity.
GUPTA: Wow.
GARLAND: And you went from a 4.7 in pain unpleasantness to a 1.1 in pain unpleasantness.
GUPTA: That's incredible.
GARLAND: Those are huge effects.
GUPTA: No drugs, just training the brain.
GARLAND: Recenter.
When you generate these peaceful and positive feelings during the practice of mindfulness, that can be analgesic in and of itself. Not only does mindfulness decrease the intensity of the pain, but it's really powerful in decreasing its unpleasantness. It just makes pain less bothersome.
So, the sensation is still there, but you're just not as upset about it.
GUPTA: Right. I think that's exactly how I would describe it.
Even Dr. Shirvalkar, a high-tech brain expert, supported this low-tech approach to pain.
SHIRVALKAR: I really believe, one of the most powerful things we can do as humans is learn to train our brain.
GUPTA: Train your brain to fight pain.
D. GUPTA: Every day, try to do a little bit more, a little bit more.
GUPTA: It sounded familiar to me.
D. GUPTA: If you train your brain not to think about these things, if you can control, I think it will work better.
GUPTA: Moms are always right. Turns out my mom had also used mindfulness to help with her pain.
D. GUPTA: I just sit quietly and focus on something nicer and say, I want this thing to go away. And it does go away.
GARLAND: Are there spaces inside?
GUPTA: No one is saying that meditation and mindfulness alone can eliminate pain for most people. Because if you've learned anything, it is that pain is complicated. And that means there is no one-size-fits- all. You got to put all of it together.
SHIRVALKAR: When someone has developed chronic pain, treating it with a single drug, or an injection, or some monotherapy probably isn't going to work. We have to address people's thinking patterns. Make sure that they're eating well, exercising as much as possible. It really requires to have a multimodal approach.
GUPTA: How are you feeling right now, just good?
MOWERY: I have no pain at all.
GUPTA: That holistic approach is what brought the most success to the people we've met during this show.
MOWERY: I started dieting right. I started working on music and doing all the things that I love doing, because I hadn't been able to do it for so long. It's wild. It's hard to describe.
HARDWICH: I realized that, you know, for 20 years, I've not been who I really am. I felt like I got my life back.
KRUGER: Try and keep up, all right?
GUPTA: I'll follow you.
In one way or another, they all got their lives back, taking control of and then conquering their pain.
Are you surprised that you feel as well as you do?
D. GUPTA: Yes.
GUPTA: You didn't think you were going to get to this point?
D. GUPTA: I thought it would be challenging. But I'm very grateful to God that I can do everything.
(SINGING) GUPTA: You seem happy.
D. GUPTA: I'm always like to be happy. Things happen. And one has to learn to live with it.
GUPTA: What do you think things are going to look like a year from now for you?
D. GUPTA: Probably same.
GUPTA: Do you think that you'll be walking even faster?
D. GUPTA: Yes.
(LAUGHTER)
GUPTA: OK.
