Book Excerpt: ‘It Doesn’t Have to Hurt,’ by Sanjay Gupta, M.D.

The neurosurgeon and best-selling author's new book offers practical advice on how to reduce chronic pain

Sanjay Gupta, M.D.,

AARP

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Published August 27, 2025

In his new book, "It Doesn’t Have to Hurt," Sanjay Gupta, M.D., reveals an array of updated approaches that offer hope for people living with chronic pain.

CNN

In his new book, It Doesn’t Have to Hurt: Your Smart Guide to a Pain-Free Life (on sale Sept. 3), Sanjay Gupta, M.D., offers science-backed resources for treating chronic pain and discovering new tools for lasting relief. In the excerpt below, Gupta, 56, explores how pain became such an important topic in his life, both professionally and personally. (You can also read our related stories 10 Ways to Relieve Pain and 11 Ways Your Diet Can Relieve Pain.)

It Doesn’t Have to Hurt: Your Smart Guide to a Pain Free Life

Bess Talbot feared she was going crazy.

At age forty-seven, she was having debilitating migraine headaches. She’d had her first one two decades earlier while she was in law school, and for a while the migraines happened only occasionally. But after she had children, they “came back with a vengeance,” she told me. Now she was suffering from them every day.

The near-constant pain was affecting every part of her life. Drugs prescribed by various doctors made her woozy and dizzy, fogging her brain. She forgot grocery lists and once left her keys in a fitting room at a department store. Not able to focus until she made her way to the parking lot, she fought back tears, trying to orient herself. Where am I? Where are my things? Where is my car? “It puts you in a very dark place,” she says.

Even when her migraines were less frequent, they could last for days and still dominated her life. “At times I thought, ‘Am I going crazy? Is this something more than a migraine? Do I have a tumor?’ At one point I was even wishing that they would find something like that just so they could operate and alleviate the issue.”

After years of trying, and failing, to find relief for her migraines, Talbot was at the end of her rope. That’s when her neurologist, stymied by her condition, recommended she travel from her home in Alabama to the Michigan Headache and Neurological Institute (MHNI) in Ann Arbor to see a physician he’d heard about named Joel Saper. Desperate, Talbot decided to make the trip. Maybe, just maybe, he could help.

Even before arriving in Ann Arbor, Talbot had phone conversations and evaluations with the team Dr. Saper had assembled. She spoke with neurologists and psychologists — doctors of the brain and the mind. She was evaluated by other specialists to fine-tune her treatment with physical and occupational therapy, as well as nutritional and pharmaceutical strategies. But the most important member of the treatment team was Talbot herself. As simple as it sounds, this is Dr. Saper’s most revolutionary concept: treating the patient not as a passive participant but as an active investigator working shoulder to shoulder with the experts. By focusing on not only the “what” of treatment but also the “who” — a patient’s history, outlook, and expectations — he created an optimal healing environment. He helped people believe they could drive their own care.

the cover of the book it doesn't have to hurt by sanjay gupta m d

Simon & Schuster

In "It Doesn’t Have to Hurt," Sanjay Gupta, M.D., shares effective options for relief that you can start practicing today to greatly reduce your chances of suffering pain tomorrow.

In the course of her weeklong hospitalization for treatment, Talbot told Saper about a high school cheerleading accident from decades earlier. The team had been practicing a challenging new formation, and as a “flier” — the cheerleading daredevil who perches atop the human pyramid — Talbot had taken a steep plunge to the floor when the formation suddenly crumbled. She landed hard on her tailbone and felt a stab of pain in her back. Then the formation next to hers toppled too, and Talbot felt her head slam as a flier in that group crash-landed on her.

The team members disentangled, practice was canceled, and Talbot slumped home in excruciating pain. She had to skip the Guns N’ Roses concert she’d planned to see that weekend with a friend, and when her doctor prescribed a bulky back brace, her mother had to alter her prom dress to accommodate it. But eventually the episode receded into the backdrop of her active life: College. Law school. Running, including marathon training and entering races as a way to manage stress.

A few years later, when she began to experience occasional migraine headaches, she did wonder if there might be a connection to her old injury. But even as the headaches worsened over time, whenever she brought up that idea with new doctors, they dismissed the link as too flimsy to pursue.

Then she sat down with Saper.

He was the first doctor to really dig into the aftermath of her fall. He learned that a few hours after the accident, her mother had insisted on taking her to the hospital emergency department. A workup with scans revealed hairline fractures in three upper thoracic vertebrae. Though none were considered serious enough to require surgery, she was admitted for a short hospital stay, followed by wearing that rigid back brace for six months. To Saper, these layers of detail were a significant part of the story — a history that held clues to her current condition.

A deeper investigation revealed a family history of migraines, which likely also increased the risk for Talbot. Without the cheerleading accident, however, that risk might never have manifested. Saper describes a person’s propensity for migraines as a big rock perched on a high hill. “Genetics put the rock near the cliff,” he says. And then “whether it’s a glass of wine or a menstrual period, a bad emotional time in a person’s life, something sort of tips it over the hill and it starts rolling.” For Talbot, the cheerleading accident and the trauma to her spine, neck, and the base of her brain had tipped the boulder. Over the years, efforts at pain relief had never addressed that deeper issue.

As Saper described to Talbot how the pieces of her pain puzzle fit together, her misery and confusion gave way to something new — a hopeful sense of possibility. He used Talbot’s history to inform her treatment plan, which now included dedicated physical therapy and exercises designed to specifically strengthen her spine and neck. Over the years, she had tried countless medications for migraines, including triptans, opioids, and others to address inflammation and depression, but no one had ever suggested adding a practical rehabilitation of the base of her neck.

The benefits of Saper’s approach — the thorough initial evaluation, the continual calibrations of her medications, and the dedicated neck physical therapy — collectively made all the difference. Talbot gained more confidence in reading and responding to her physical and emotional cues for an approaching migraine. What’s more, when she began to experience her pain changing as she and Saper fine-tuned the treatments, she felt newly encouraged to focus more at home on exercise, stress management, and meditation. Even when she can’t do all of them all of the time, they are an antidote to hopelessness. “It was life changing for me,” Talbot says. And she told Saper so. “I said, ‘You’ve given me my life back.’ And I wonder, if I’d met him twenty years ago, you know, what a better mother I would have been. What a better wife I would have been. What a better everything I would have been but for the migraines.”

Talbot’s healing journey began simply, with a fresh conversation about pain. Dr. Saper had brought medical precision, multidisciplinary expertise, and a deeply collaborative partnership with his patient to frame her relationship with pain in a new way, rewriting the pain script and providing new options for treatment and prevention. I start with Talbot’s story because it offers a sense of optimism for the hundreds of millions of people suffering from chronic pain, and particularly those who have felt forgotten, suffering inside bodies they believe have betrayed them.

There is a very real path forward through pain and beyond. In this book, I walk you through the steps that I am confident will take you there.

A dizzying amount of medical progress has been made since I became a neurosurgeon more than twenty-five years ago. We can remove tumors once considered inaccessible and fuse spines previously thought to be too broken. We have a pretty good idea where certain emotions and addictions lie in the brain and can even tinker with them using deep brain stimulation. Pain, because of its complexity and subjective nature, has presented a larger challenge, and yet even there, we have made important advances.

Over the past few decades, we’ve learned more than ever about the true nature of pain. We better understand what causes it, what may best relieve it, and what we can do to minimize or even eliminate certain types of pain. Many of those life-changing insights have not yet been made easily available to the public. With this book, I want to change that. Over the past few years, I’ve placed both my neurosurgeon’s and my investigative journalist’s lens on the problem of pain, and I am now convinced: It doesn’t have to hurt.

There is hope. There is help. And there is healing beyond anything we may have imagined.

In these pages, I offer new accessible lessons from doctors and researchers who specialize in pain and have been steadily changing the way we understand and experience it. You will hear directly from patients, many of whom struggled with chronic pain through a broken landscape of health care but found relief through conventional (and sometimes unconventional) tools.

Their consistent message is this: if you are in pain, there are far more effective options than you may have previously realized, as well as important things you should start doing today to greatly reduce your chances of suffering pain tomorrow. These are strategies I have started incorporating into my life, as well as the lives of my wife, teenage kids, and eighty-year-old parents. The significance of reducing and even eliminating pain cannot be overstated. Nearly one-quarter of adults (24.3 percent) say they suffer from chronic pain, and nearly one in ten (8.5 percent) report high-impact pain — pain so bad it not only persists but in the previous three months also frequently limited their daily life and work activities. The outlook worsens with age. Among respondents to the 2023 National Health Interview Survey, the percentage of adults who had chronic pain in the past three months increased from 12.3 percent of those aged eighteen to twenty-nine, to 36 percent — more than one-third — of those age sixty-five and older. High-impact chronic pain increased with age too, from 3 percent of those aged eighteen to twenty-nine to 13.5 percent of those age sixty-five and older. Among those who reported chronic pain, almost two-thirds still suffered from it a year later.

New cases of chronic pain have also skyrocketed, and they now occur more often among US adults than new cases of most other common conditions, including diabetes, depression, and high blood pressure. These numbers translate globally. About one in five people around the world experience some form of chronic pain, making it one of the biggest burdens on the global health care system.

We recently got a glimpse of where Americans feel that pain the most.

In its 2022 survey report, “A Chronic Pain Crisis,” the US Pain Foundation revealed the most common pain conditions:

Back pain (67 percent)
Joint pain due to arthritis (56 percent)
Neuropathy (nerve pain; 53 percent)
Neck pain (51 percent)

Also widespread:

Muscle spasms (38 percent)
Hip pain (37 percent)
Headache (36 percent)
Fibromyalgia (36 percent)
Osteoarthritis (33 percent)
Irritable bowel syndrome (28 percent)
Migraine (27 percent)

Perhaps most striking, only 35 percent of respondents said their pain was a direct result of trauma or injury, such as from a car accident or workplace mishap. The vast majority of people in the survey cited no obvious cause, or entirely separate health conditions, that contributed to their pain. In fact, 20 percent had two to five contributory conditions, 30 percent had six to ten conditions, 24 percent had eleven to fifteen conditions, and 21 percent had fifteen or more contributory conditions. At least one person had a staggering forty-two conditions. Can you even imagine the burden that causes in their lives? Pain carries an enormous amount of physical, social, and emotional baggage, which is why, in part, it has been so hard to treat and too often ignored by doctors.

Pain can be acute or chronic. Acute pain is sudden or urgent, whereas chronic pain is long-standing, typically beyond three months. Acute pain is usually a straightforward response to a discernible injury. It serves a clear function: to grab our attention and teach us a lesson about avoiding potentially harmful stimuli in the future.

Chronic pain, however, can be a misfire of the body’s central nervous system (CNS), which can be particularly bewildering because the persistent pain serves no obvious purpose. In some cases, though, the cause may be less a misfire and more a stubborn mystery until scientific understanding advances enough to solve it. Until then, any insights into why a person’s system has gone haywire remain buried in complexities that have baffled the best minds in science and medicine since ancient times.

While writing this book, I was reminded of something I learned as a child: humans have a tendency to try and find lessons in awful situations, to try and make sense of them. They search for meaning in misery, a moral to the story that sometimes leads to blaming themselves. Yet when it comes to chronic pain, there’s often no lesson to be learned and no blame to be placed. Sometimes pain is just that — pain. Nothing more.

Yet this hasn’t kept societies from marginalizing and ignoring those who suffer from pain, in particular due to four chronic conditions: migraine, fibromyalgia, irritable bowel syndrome, and endometriosis. These conditions, among others, are often thought of as “invisible” or “silent,” not only because the symptoms aren’t always obvious but also because testing often doesn’t reveal anything abnormal. For most mainstream medicine, that means there’s nothing clear-cut to treat. The unfortunate — and incorrect — inference is that if the best medical minds can’t solve the problem, the problem probably “doesn’t really exist.”

The lack of an objective standard of pain has even given rise to the term subjective suffering, which suggests that one person’s pain is open to another’s interpretation. Too often, this leads to dismissive attitudes toward those suffering from chronic pain. Some people judge them as personally failing or not trying hard enough to get over it. Others might see their complaints as a ruse to get drugs or to get out of work. But for those of us in health care whose aim is to relieve suffering — measurable or not — the fact that pain is subjective does not mean that it isn’t real. It’s just more enigmatic.

One reason I wanted to write this book is because some members of my own family suffer from chronic pain, and being immersed in their experiences has taught me a lot. For example, I have seen firsthand how challenging it is for them to navigate the health care system, even with my help. I have personally witnessed remarkably talented doctors being dismissive of their symptoms, even after reviewing detailed records of their near-daily pain.

This is problematic, of course, but it’s also an indicator of how complicated the problem is. What I’ve learned from my patients, colleagues, and family members, as well as from my own experience, is that pain and suffering can present in infinite ways, and yet we have tremendous control in choosing how we’ll respond. We can not only change our relationship with pain, we can change pain itself.

That’s what this book is about.

In the pages ahead, you will learn things you can start doing today— physically, nutritionally, mentally, and behaviorally — that can greatly reduce the chance of developing pain in the future. Some of it may surprise you. For example, you may have heard of rest, ice, compression, elevation treatment, known as RICE, to help with an injury. Increasingly, the evidence is instead pointing us toward MEAT — movement, exercise, analgesia, treatment. This amid a flurry of other tweaks and catchy acronyms over the years, including POLICE (protection, optimal loading, ice, compression, elevation), PEACE (protection, elevation, avoid anti-inflammatories, compression, education), and LOVE (load, optimism, vascularization, exercise). The thing these strategies all have in common is the emphasis on letting your body’s natural healing processes work normally, rather than interrupting or rushing to manipulate them.

I will explain later why this is so important, but the headline is that not all inflammation is necessarily bad. And among the most critical tools you will need are muscle-massage foam rollers, which with regular use can diminish your chances of pain, especially after a soft tissue injury. As you will learn, the thin connective tissue called fascia, which surrounds all our muscles, can get painfully stiff and tight throughout your life, so keeping it loose and flexible with those rollers is critically important. There is also new, encouraging data emerging on acupuncture, trigger point injections, and hands-on physical manipulation as well. And what about substances like cannabis and cannabinoids such as cannabidiol (CBD), ketamine, and the broad class of psychedelics? I’ll examine the research we have so far on all of these, as well as the case for some natural pain relieving supplements.

With emerging evidence-based science, medical advances, and our own wisdom, we can rewrite the story of pain, as well as our own lifelong potential for managing it—and often preventing it. I’m ready to show you how.

While conducting dozens of interviews for this book, I saw firsthand that experts in pain science and medicine are impatient to see change in the understanding, diagnosis, and treatment of pain. In fact, over the past several years, despite increased spending on pain and new approaches to it, from better imaging technology to new drugs and surgical options, the prevalence and impact of chronic pain have worsened. A consortium pain task force white paper laid out these four reasons why:

Both patients and medical practitioners labor under the mistaken idea that most pain problems can be fixed... with a drug or procedure.
Medical school and graduate courses still emphasize… opioid medications rather than considering other options.
The business model of medicine... has promoted simplistic solutions to complex problems.
Patients are often regarded as passive participants, with little emphasis placed on self-care, pain prevention, or therapies that engage self-care strategies, despite demonstrated (lasting) benefit.

These four barriers can be overcome. And I am optimistic that the field of pain is ripe for massive change.

Why? Because we — both patients and doctors — are at the dawn of a new era in the way we understand and respond to pain.

Here are some key takeaways I explain in the upcoming chapters:

The brain “creates” pain, but it also has the capacity to profoundly change our experience of pain, reducing or even eliminating it.
Because we have unique pain signatures in our own brain waves, highly personalized pain treatments may be possible.
Your brain responds to sensory nerve signals by activating neural circuitry, which triggers physiological changes throughout the body. This two-way brain-body interaction creates opportunities for changing pain circuitry and chemistry.
Gender, racial, and other systemic biases and inequities in pain treatment are now in the spotlight. A broad recognition of those biases will pave the way for more effective and individualized care.
Advances in technology, including AI assists for pain assessment and management, are charting a new path for safer, more precise, and effective treatments.
There is more evidence than ever before about the benefits of sleep, a healthy diet, exercise, mindfulness-based pain management (MBPM), myofascial therapy, yoga, and specialized psychotherapies, and as a result more doctors are focusing on them.

And most encouraging of all:

The push is on from all corners to bring a dose of reality to pain research, with new efforts to conduct treatment trials. Instead of pain sufferers being minimized, they are increasingly sought out to share their experiences, including being added to research committees and advisory boards. This is a long overdue acknowledgment that we should always start by listening to patients to understand their unique problems and needs.

If you’ve read anything about pain over the past twenty years, you have likely been angered by the opioid epidemic, a tragedy fueled by ignorance, arrogance, and greed. Like me, you have probably been saddened at seeing lives destroyed or devastated by addiction. I was a young trainee in neurosurgery at the beginning of the epidemic and followed it closely as a doctor and journalist — but there’s an untold part of that story I want to share.

Because opioids have consumed most of the conversation, most people don’t even realize there are plenty of other effective options to help relieve pain. While I was writing this book, the FDA approved a new non-opioid pain medication for the first time in more than twenty-five years, and nowadays there are entire emergency room systems that use hardly any opioids. (I’ll take you inside one to understand how it was done and what it means for the future of pain management.)

Some elements of pain relief and prevention have actually been around a long time, in the form of ancient healing practices handed down over thousands of years. Despite being effective for many people, they have too often been unfairly dismissed from serious consideration by Western medicine. I will explain how to apply some of these traditions to our daily lives. Finally, there have been breathtaking breakthroughs in pain management that would have been unimaginable only a few years ago. Modern science and ancient wisdom have collectively begun to crack the code on pain. You can too.

As you read the book, remember this. We are the most essential experts on our own pain. If we pay close attention to our own bodies, strategies to address our pain come into clearer focus. Each of us has inner resources that can help prevent or reduce pain now and for the rest of our lives. This begins with connections — between doctor and patient, within families, and among communities of caring. But the most important connection is the one within us, between body and brain.

Prevention is often the most powerful antidote to pain, giving you a range of ways to control your risk for acute and chronic pain. In this book, I’ll recommend some tips and strategies that may reduce your vulnerability, strengthen your resilience to pain, and, when it does occur, work with the fullest range of tools to heal more readily.

I’ll begin by reframing your understanding of pain, so you and your health care providers can intervene in the way your brain and body process those signals.

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Sanjay Gupta, M.D., is CNN’s chief medical correspondent and author of 12 Weeks to a Sharper You and Keep Sharp: Build a Better Brain at Any Age, based in part on the work of the Global Council on Brain Health, convened by AARP, and published in collaboration with AARP.