Chronic pain doesn’t have to control your life. In It Doesn’t Have to Hurt, Sanjay Gupta explains how chronic pain develops when multiple body systems malfunction together, and why standard medical treatments often fall short. He argues that effective pain management requires a holistic, personalized approach combining physical and mind-body treatments.
Gupta draws on his experience treating complex pain conditions to offer practical strategies you can implement immediately. This guide explores his key recommendations—from pharmaceuticals and movement to optimism and social connection.
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It Doesn’t Have to Hurt Book Overview
Chronic pain can feel like it takes over your entire existence, as if you’ve gone from being someone who experiences pain to someone whose life is defined by it. However, neurosurgeon Sanjay Gupta promises that no matter how inescapable it seems, you can effectively manage your pain and reclaim your life. In It Doesn’t Have to Hurt (2025), Gupta explains how chronic pain develops and why traditional medical treatments are often ineffective. He then provides numerous strategies you can incorporate into a holistic treatment plan to minimize your pain and maximize your quality of life.
As a neurosurgeon, Gupta has direct experience treating patients with complex pain conditions, particularly those involving the brain and spine, giving him intimate knowledge of how the nervous system generates and perpetuates pain signals. He received his medical training at the University of Michigan and Emory University and has a clinical practice at Grady Memorial Hospital in Atlanta. He’s also CNN’s chief medical correspondent and an associate professor at Emory University’s Rollins School of Public Health.
We’ll begin this guide with Gupta’s explanation of how pain changes from acute (short-term) to chronic (long-term), and why each person’s experience with chronic pain is unique. Then, we’ll explore various treatment options that Gupta suggests, divided into two categories:
- Physiological treatments (which heal the body and treat the physical aspects of pain)
- Mind-body treatments (which boost your overall well-being by improving your mental state)
The Nature of Chronic Pain
Gupta gives an overview of what chronic pain is and how it develops. This understanding creates a foundation upon which to build your treatment plan.
In this section we’ll explain how “normal” pain turns chronic due to malfunctions in numerous bodily systems that interact and reinforce one another. We’ll then discuss why everyone’s chronic pain experience is different—even though the physical mechanisms are the same—and why it’s crucial to develop a personal, holistic plan for your unique situation.
How Normal Pain Becomes Chronic
Gupta explains that in normal circumstances, pain serves an important function: It alerts you that something’s wrong so you can properly tend to an injury or illness. However, your body can malfunction and cause pain to persist long after the problem is resolved.
Pain goes from acute (short-term) to chronic (long-term) because multiple body systems work in dysfunction:
- Your immune system continues to release inflammatory molecules long after they’re needed for healing.
- Your endocrine system keeps producing stress hormones that make you more sensitive to pain.
- Your muscular system develops compensatory patterns that create new sources of pain—for instance, if you have chronic pain in one ankle, you might overuse your other leg and injure it as well.
This means that chronic pain is the result of numerous problems reinforcing one another, which is why it’s so pervasive and difficult to treat.
Everyone’s Pain Is Different
Although the physical mechanisms of chronic pain are the same for everyone, Gupta says each individual’s pain is unique and deeply personal. Your experience of chronic pain—meaning both how it manifests in your body and how you handle it psychologically—draws from your entire life history. This includes past injuries and illnesses, as well as your genetic predispositions and even emotional traumas.
Gupta adds that your personal pain condition requires an equally personalized treatment plan, and you should be actively involved in creating it. It’s important to tell healthcare providers not just about your current symptoms, but also about past experiences and how they could be impacting you. With your observations and insights to guide them, medical professionals may be able to identify patterns and connections that standard medical evaluations miss.
Physiological Treatments for Chronic Pain
We’ve discussed how acute pain becomes chronic and why your unique chronic pain requires a personalized treatment plan. For the remainder of this guide, we’ll explore various treatment options that Gupta presents.
In this section we’ll discuss different ways to treat the physical symptoms of pain and improve your physical health. We’ll start by briefly discussing the wide variety of medical treatments that are available today, then explore how movement and exercise can, counterintuitively, relieve pain rather than aggravating it. Next, we’ll examine the role nutrition plays in healing, why rest is crucial, and how you can rest effectively while suffering from chronic pain.
Physiological Treatment #1: Pharmaceuticals
Gupta says that while pain management should involve more than traditional medical treatments, those treatments still play an important role. There are numerous pharmaceuticals (medications) available, and they extend far beyond general painkillers.
He gives detailed guidance on some common over-the-counter medicines: Acetaminophen (Tylenol) works best for headaches, but puts strain on the liver, so heavy drinkers in particular should be cautious. NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen effectively treat inflammation and musculoskeletal pain, but carry risks for those with heart conditions, ulcers, or kidney disease. Aspirin, while effective for pain, thins the blood and can lead to bleeding risks, especially in older people. Gupta doesn’t recommend using any of these drugs for long-term pain relief unless your doctor says otherwise, as they all carry harmful side effects.
Next, Gupta discusses the potential uses of some prescription medications. The seizure medicine gabapentin is an effective treatment for nerve pain, though side effects like dizziness and memory issues are common. Antidepressants, particularly duloxetine, have shown moderate effectiveness in treating chronic pain conditions, though this is a new area of study and evidence remains limited. Similarly, the anesthetic ketamine shows promise for treatment-resistant pain conditions, but it isn’t yet FDA-approved for pain management.
Finally, Gupta discusses opioid medications: powerful but potentially addictive painkillers such as oxycodone. He acknowledges that the opioid crisis caused widespread addiction and abuse, particularly in the US, but he argues that opioid medications do have legitimate uses. Opioids are particularly helpful for patients suffering from cancer, and for those who can’t tolerate other types of drugs. He therefore criticizes what he views as an overcorrection: Doctors have gone from overprescribing opioids to blocking responsible opioid users from getting the medicine they need.
Physiological Treatment #2: Movement
Gupta asserts that—contrary to the traditional advice to rest and avoid activity—movement can be one of your most powerful tools to relieve pain and improve function. For one thing, your body is designed for movement and needs regular exercise to maintain itself. Therefore, prolonged inactivity causes further damage that can actually lead to more pain. When you don’t get enough exercise, your muscles weaken, your joints become stiff, and your cardiovascular system becomes less efficient at delivering the oxygen and nutrients you need, just to give a few examples.
Gupta says treating chronic pain with movement requires you to strike a balance between challenge and comfort: You have to push yourself hard enough to become stronger, but not so hard that you cause further injury.
He recommends that you start with aquatic exercises, such as walking in the shallow end of a pool. These are generally safe and effective because your natural buoyancy will take some of the strain off your joints, while the water provides gentle, steady resistance to help strengthen your muscles.
The author also says the fear of movement, called kinesiophobia, often becomes a bigger problem than the original injury. When you avoid activities because you’re afraid they’ll hurt, you create a downward spiral of deconditioning and increased pain sensitivity. Your nervous system becomes hypervigilant about movement-related sensations, and it starts to interpret normal feedback as dangerous—for instance, you might mistake an ordinary muscle stretch for excruciating pain. This discourages you from moving around, which only leads to further harm and hypersensitivity.
Physiological Treatment #3: Nutrition
Your dietary choices can also strongly influence your pain levels, for better or for worse. This is largely due to inflammation: As we discussed before, chronic pain often involves systemic inflammation, which Gupta says your diet can aggravate or reduce.
Anti-inflammatory eating patterns, such as the Mediterranean diet, have shown significant benefits for people with chronic pain conditions. These approaches emphasize whole foods rich in omega-3 fatty acids, antioxidants, and phytonutrients that combat inflammation at the cellular level. Wild-caught fish, colorful vegetables, nuts, seeds, and olive oil are all excellent choices for a pain-management diet. Conversely, Gupta urges you to avoid processed foods, added sugars, and refined oils as much as possible, since those have been shown to make inflammation worse.
Gupta adds that healthy, sustainable dietary changes require practical strategies designed to fit your lifestyle. Therefore, he suggests you make a series of small changes that build upon one another, rather than trying to immediately overhaul all of your eating habits. For example, you might start by adding one anti-inflammatory food to each meal, such as having fruit with breakfast or a salad for lunch. You could also gradually reduce your portion sizes of inflammatory foods like processed bread and sugary cereals instead of just quitting them entirely.
Physiological Treatment #4: Sleep
Finally, Gupta says the relationship between pain and sleep creates a vicious cycle: Pain makes it hard to sleep, and poor sleep intensifies pain. Breaking this loop is difficult, but necessary.
The author explains multiple ways that sleep deprivation makes chronic pain worse. First, it lowers your pain threshold, so things that normally wouldn’t bother you become painful. Secondly, your emotional regulation deteriorates—not only do you feel more pain, you’re also less able to cope with it. Finally, fatigue makes it difficult to think clearly, which impairs your ability to effectively use your pain management strategies.
Gupta suggests a number of ways to improve your sleep:
- Design an effective resting environment. Make sure the room is dark and comfortably cool. Arrange pillows or cushions to support you in whatever position minimizes your pain and keeps you as comfortable as possible.
- Create a consistent sleep schedule. Going to bed and waking up at the same time every day regulates your circadian rhythm, which helps you to rest even when pain makes sleep difficult.
- Practice relaxation techniques before bed. Practices such as deep breathing exercises or meditation can reduce both your physical tension and the anxiety you might feel about facing another long, uncomfortable night.
- Use medication strategically. While Gupta doesn’t recommend this as a long-term solution, pain medications or sleep aids at bedtime can provide the initial help you need to break the cycle of pain and sleep deprivation.
Mind-Body Treatments for Chronic Pain
Gupta asserts that the medical community has long seen the physical and mental aspects of pain as separate, and that this has hindered effective treatment for decades. He argues that integrated mind-body approaches to pain management offer more effective and longer-lasting relief than physical treatments alone.
In this section we’ll review a number of mind-body strategies that Gupta presents—while not “treatments” in a traditional sense, they nonetheless help to relieve chronic pain and improve your quality of life. These strategies include developing a realistic yet optimistic mindset, building and maintaining strong social connections, and deliberately focusing on pleasant experiences.
Mind-Body Treatment #1: Optimism
Gupta says your beliefs profoundly influence how you experience pain, as well as your ability to recover from it. Research consistently shows that people who maintain hope, and who believe in their ability to improve, experience better outcomes than those who feel helpless and assume their chronic pain will never get better. The author urges you to adopt a realistic yet hopeful perspective: Acknowledge the challenges you face, but keep faith in your ability to endure and overcome those challenges.
Building this mindset requires practical strategies applied consistently. Gupta suggests that you start by challenging your catastrophic thoughts and replacing them with more balanced perspectives. For instance, instead of thinking “This pain will never end,” you might reframe it as “I’m having a bad day, but I’ve managed days like this before.”
As you work to cultivate this more optimistic mindset, Gupta says you can set small goals each day to build your confidence and momentum. To continue the previous example: Consciously reframing every negative thought you have might seem impossible, but you can certainly reframe just one thought each day. With time and practice, you’ll find that those negative thoughts come less frequently and are easier to handle when they do arise.
The Placebo and Nocebo Effects
Gupta adds that optimism is a legitimate medical intervention based on known neurological principles—namely, the placebo effect and its opposite, the nocebo effect.
The placebo effect demonstrates the concrete power of expectation in pain management. In study after study, a significant number of patients who received a fake treatment (such as a sugar pill) showed genuine improvement, simply because they believed the “medicine” would help. Gupta explains that this happens because when you expect to feel better, your brain releases its own cocktail of pain-relieving chemicals to create actual physiological changes.
Conversely, the nocebo effect shows that negative expectations can worsen pain and create new symptoms. The principle is the same: Your mindset creates real changes within your body. If you expect to be in pain, your brain will react by tensing your muscles, releasing chemicals that cause inflammation, and doing other things that genuinely make your pain worse.
Mind-Body Treatment #2: Connection
Gupta says that strong social connections are crucial for pain management. This is because humans are social creatures—we evolved to live in groups, and we experience isolation as a genuine survival threat. As a result, loneliness causes the brain to release stress hormones like cortisol that increase inflammation and pain sensitivity.
The quality of your relationships matters more than quantity when it comes to pain relief. Supportive relationships where you feel heard, understood, and valued provide a buffer against chronic pain: Your nervous system calms, and you produce far less of those painful stress hormones. Conversely, relationships where you commonly face criticism, dismissal, or excessive demands can cause additional stress that only makes your pain worse.
However, chronic pain often makes normal socializing difficult, so you may need to develop strategies and creative workarounds to maintain your relationships. You could pick places to meet where you won’t be expected to stay for too long and can easily leave if your pain starts to become an issue—for instance, a coffee shop or a bar may be more suitable than going to the movies or on a lengthy walk. On days when even that much is too taxing, you might keep in touch through social media or a phone call.
Gupta also suggests that you look for chronic pain support groups. By their very nature, such groups are good places to meet people who genuinely understand what you’re going through, and to get support and advice.
In addition to forming and nurturing close relationships, Gupta says that doing meaningful work helps maintain your sense of purpose and connection, even if you can only participate in limited ways. For example, if you’re passionate about the work a local food bank does, see if there’s some way you can help—if you can’t physically pack boxes, perhaps they need someone to greet and direct people as they come in.
Mind-Body Treatment #3: Savoring
Gupta urges you to, whenever possible, consciously focus on good experiences rather than dwelling only on your pain. He calls this strategy savoring: deliberately finding and appreciating positive moments in your day-to-day life. Research shows that people who practice savoring experience progressively less intense pain and greater emotional well-being, even if their physical condition remains unchanged.
Savoring works through multiple psychological and neurological mechanisms that directly counter pain’s effects. When you focus attention on positive experiences, you activate brain regions associated with pleasure and reward, releasing endorphins and other feel-good chemicals that provide natural pain relief. Furthermore, savoring the memories of positive experiences continues to produce these benefits, sometimes long after the moment has passed. You can even savor things that haven’t happened yet—anticipating future pleasures can make you feel noticeably better in the present.
Savor the Past, Present, and Future
Gupta offers a variety of techniques you can practice to savor your past, present, and future experiences. One suggestion is to keep a journal of the positive moments you experience each day, however small or insignificant. Taking pictures of things that brought you a moment of joy is another good way to remember those happy instances.
During pleasant activities, you can intensify your happiness by mindfully focusing on the experience. It also helps to share your enjoyment with others; doing so forces your attention onto what’s happening and away from distracting thoughts about your pain. Finally, planning future enjoyable events—even simple ones like meeting your friends for a drink—creates positive anticipation that will help you through difficult days.
