PDF Summary:It Doesn't Have to Hurt, by Sanjay Gupta

Chronic pain can feel like it takes over your entire existence. However, neurosurgeon and CNN medical correspondent Sanjay Gupta promises that no matter how inescapable your pain seems, you can learn to manage it and reclaim your life. In It Doesn’t Have to Hurt, Gupta explains how chronic pain develops, why traditional medical treatments are often ineffective, and how you can build a holistic plan to manage both the physical and psychological aspects of chronic pain.

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 is unique. Then, we’ll explore various treatment options, including physiological treatments and “mind-body” treatments. Our commentary will provide additional information from scientific and medical research, as well as specific actionables from fields ranging from personal health (such as in The Joy of Movement) to self-help (like Feel-Good Productivity) to help you put Gupta’s principles into practice.

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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.

(Shortform note: A healthy diet can improve your life in ways beyond reducing pain levels. For instance, the MIND diet—short for “Mediterranean-DASH Intervention for Neurodegenerative Delay”—is designed to support cognitive health and help stave off dementia. The MIND diet merges the Mediterranean diet’s emphasis on olive oil, fish, nuts, and fresh produce with the DASH diet’s focus on reducing sodium while incorporating whole grains, lean proteins, and vegetables. This diet is believed to boost your brain by fighting inflammation and oxidative stress throughout your body, including in your brain tissue.)

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.

(Shortform note: Many behavioral experts support Gupta’s suggestion to make a series of small changes rather than a few major ones. For instance, in Tiny Habits, BJ Fogg says successful behavioral changes (such as eating healthier) happen when you have enough motivation and ability to make the change, as well as a prompt to get you started. Fogg also argues that motivation is unreliable, so it’s crucial that the changes you try to make are as small as possible in order to minimize the ability requirements. Phrased more simply, small changes are easier than big changes, and it’s better to successfully make incremental improvements than to fail at making dramatic life changes.)

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.

(Shortform note: We’re often told that adults need eight hours of sleep per night, but the quality of sleep is just as important as the quantity—and sleep quality is often what chronic pain interferes with. How can you tell if you’re getting good-quality sleep? According to the US Sleep Foundation, some clear signs include: 1) You fall asleep within half an hour of getting into bed; 2) You wake up only once, or not at all, in the middle of the night, and you fall back asleep soon after; 3) You feel refreshed and energized when you wake up.)

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.

More Tips to Help You Sleep

In The Sleep Revolution, Arianna Huffington offers additional tips for improving sleep that Gupta doesn’t mention:

Avoid alcohol. While drinking might help you fall asleep, it will prevent you from getting restful sleep. You’ll likely find yourself wide awake (and possibly hungover) as soon as the alcohol is out of your system.

Try acupuncture. According to a study, this centuries-old practice had a positive effect on 93% of insomnia patients.

Sip (or sniff) some lavender. Studies suggest that the herb has a relaxing effect, which can set the stage for a good night’s sleep. Huffington writes that in Germany, lavender tea is an approved treatment for insomnia. You can also try spritzing some lavender onto your pajamas or sheets.

Empty your mind. To help you reduce anxiety-producing thoughts, try doing a “mind dump” before bed: Write down your to-do list for the next day so that your thoughts won’t keep you up at night.

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.”

(Shortform note: In Learned Optimism, psychologist Martin Seligman describes a method to examine and reframe your negative thoughts. First, ask yourself whether the thought is true: What evidence do you have for it and against it? Next, ask yourself whether that thought—true or not—is useful to you. Finally, consider more empowering thoughts and beliefs you could replace it with, as shown in the example above.)

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.

(Shortform note: This strategy of setting small goals takes advantage of what Mark Manson (The Subtle Art of Not Giving a F∗ck) calls the motivation loop. Manson says many people misunderstand how motivation works—they think motivation has to come first, and that it leads to action. However, motivation and action are a cycle: Motivation can lead to action, but taking action also creates more motivation to keep going. Therefore, by starting with some small action (such as reframing just one thought), you’ll find the motivation to keep working toward a more optimistic mindset.)

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.

(Shortform note: While the placebo effect can be a powerful tool to relieve pain, it only affects how you perceive your symptoms. In other words, the placebo effect may help you feel better, but if you’re still injured or sick, it won’t help you get better. This is important to note because if you think you’re more recovered than you really are, you run the risk of overexerting yourself and causing further harm.)

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.

(Shortform note: Some experts assert that not only can psychological factors cause immediate, noticeable symptoms of pain, but certain psychological symptoms can increase the risk of physical diseases: For instance, some research suggests that panic attack symptoms increase the likelihood of developing heart disease, depression can cause allergies, and schizophrenia can cause diabetes.)

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.

(Shortform note: Gupta discusses the importance of good friends to help you with pain management, but casual acquaintances can also be good for your health in other ways. Studies have shown that having a lot of casual acquaintances significantly boosts people’s well-being. The more people you know in passing—and the more frequently you interact with them—the more likely you are to be happy.)

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.

(Shortform note: In addition to the physical limitations Gupta discusses, people who suffer from chronic pain often face social stigma as well, which makes normal socializing even more difficult. Researchers found that people who express pain without some kind of visible injury tend to experience judgment and intolerance from others. This happens because people mark those suffering from chronic pain as “different” or “deviant.” They often make negative assumptions, such as that the person must be faking their pain, or that they should be able to hide it and function normally in spite of their discomfort.)

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.

(Shortform note: The meaningful work Gupta describes can improve your overall well-being because it fulfills the fundamental human need to feel important—to know that you’ve made valuable contributions to something greater than yourself. In The Courage to Be Happy, Ichiro Kishimi and Fumitake Koga—drawing from the work of psychiatrist Alfred Adler—say that feeling valuable is the key to happiness, and that you feel valuable when you make yourself useful to others.)

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.

(Shortform note: Research strongly supports what Gupta says about the benefits of savoring—in fact, some experts say it’s a core principle of positive psychology. Furthermore, you can apply savoring to your relationships to form stronger connections, which Gupta has said is another effective treatment for pain management. This practice is called relational savoring, and it simply means that you make a point of recognizing, appreciating, and remembering the times when someone else does nice things for you. This practice makes you feel more appreciative toward that person and more secure in your relationship with them.)

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.

(Shortform note: Savoring leverages what psychologists call the broaden-and-build theory. In Feel-Good Productivity, doctor and productivity expert Ali Abdaal describes this theory in more detail. Abdaal explains that positive emotions make you more creative (they “broaden your mind”)—this, in turn, could help you create more positive experiences to savor in the future. Good feelings also build a reserve of mental energy that you can draw on when you’re tired or feeling down, such as when you’re struggling with chronic pain.)

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.

(Shortform note: Savoring past experiences can also be seen as practicing gratitude. While the benefits of gratitude are well known, it can be difficult to remind yourself to focus on what’s going well, particularly if you’re struggling with pain or other difficulties. Psychologists suggest overcoming this difficulty by establishing a daily gratitude practice, such as keeping a gratitude journal, to create a habit of thinking grateful thoughts. Some self-help practitioners also suggest using visual reminders to trigger thankful thoughts. For example, place a picture of something you really appreciate where you’ll see it often. The specific gratitude practice is less important than the habit of doing it every day.)

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.

Be Content With the Present, Yet Excited for the Future

Gupta’s advice to savor both the present and the future echoes what Daniel Z. Lieberman and Michael E. Long say in The Molecule of More: Genuine, long-term happiness requires you to balance excitement for future possibilities and contentment with your present circumstances.

Lieberman and Long say the easiest way to find this balance is to look for a career or hobby that demands your full attention in the present but also gives you future goals to work toward. This works because activities that keep you focused will stop you from thinking about the future, while having milestones to look forward to helps satisfy the dopamine-driven urge for “more.”

Painting is an excellent example of this. Each brushstroke demands the artist’s full attention, yet the artist also needs to have an idea of what the painting will look like when it’s finished—that final product is the goal they’re working toward.