# Sanjay Gupta & Eric Topol - Discuss “It Doesn’t Have to Hurt” book

An episode of [Ground Truths](https://invisiblenetwork.ai/podcast/1728526108), 5 Sep 2025, 22 min.

Audio: https://api.substack.com/feed/podcast/172589158/ea1eed16bdd8750c1741dbf2b90e0533.mp3

Thank you Jose Bolanos MD, Dr. Zeest Khan, Lawrence Toole, Julie, Stephen B. Thomas, PhD, and many others for tuning into my live video with Dr. Sanjay Gupta. Join me for my next live video in the app. A Brief Summary of Our Conservation We discussed the new understanding and approach to chronic pain, which affects nearly 1 in 4 adults. Dr. Gupta gets personal telling the story of his wife, Rebecca, who has an autoimmune disease and at one point he had to carry her up stairs. He also tells the story of his mother who had a back injury and didn’t want to live because of the pain. How his family members got relief is illuminating. Our whole understanding and approach to pain has changed, with the acronym change from RICE to MEAT. A newly approved drug Suzetrigine (Journavx) exploits the sodium channel gene mutation initially discovered via a family of fire walkers. It’s the first new pain medicine approved for more than 2 decades. Many other new non-opioid treatments are reviewed, no less lifestyle changes (anti-inflammatory diet and sleep), and acupuncture. Sanjay’s research over the past few years has led to a video special on CNN with the same title as the book, set to air 9 PM EST Sunday. If you know someone suffering chronic pain, please share the post. Get full access to Ground Truths at erictopol.substack.com/subscribe

## Transcript

[0:00] But we're going to make up for lost time with a great
[0:02] discussion of your new book.
[0:04] SPEAKER_01: It doesn't have to hurt.
[0:06] SPEAKER_01: It's about pain.
[0:07] And it's a topic that involves a fourth of Americans or people
[0:12] that have chronic pain.
[0:13] SPEAKER_01: It's a big deal.
[0:15] SPEAKER_01: And you've given a whole new outlook on it.
[0:17] SPEAKER_01: And what I thought we'd start with,
[0:19] SPEAKER_01: Sanjay,
[0:19] SPEAKER_01: you get very personal in the book,
[0:21] SPEAKER_01: which is really admirable.
[0:23] SPEAKER_01: And you talk about your wife, Rebecca, who has an autoimmune disease.
[0:27] SPEAKER_01: so bad that you had to carry her up the stairs.
[0:31] SPEAKER_01: And can you tell us how she was able to get on top of her pain,
[0:38] SPEAKER_01: chronic pain problem and emerge doing really well?
[0:42] SPEAKER_00: Yeah, that was a tough one, Dr. Topol.
[0:45] SPEAKER_00: And just to give you a little context,
[0:49] a few years before she started developing symptoms of her
[0:52] autoimmune disease,
[0:54] SPEAKER_00: very active.
[0:55] SPEAKER_00: I mean, we would do triathlons together.
[0:56] SPEAKER_00: We would do the Malibu triathlon out in your neck of the woods and
[1:00] SPEAKER_00: And then she started to get significant symptoms.
[1:05] SPEAKER_00: It was joint pain, sometimes rash.
[1:08] SPEAKER_00: She carried a diagnosis of psoriatic arthritis at times.
[1:12] SPEAKER_00: I remember talking to her once when she was in the throes of pain,
[1:16] SPEAKER_00: and I asked her to sort of point to where it hurt.
[1:19] SPEAKER_00: And she pointed to a place on her body and said,
[1:22] SPEAKER_00: this is the only place that doesn't hurt on my body.
[1:24] SPEAKER_00: And so it was significant.
[1:26] SPEAKER_00: What ended up helping her,
[1:28] SPEAKER_00: in addition to some of the various medications that are out there,
[1:32] SPEAKER_00: and you see ads for a lot of these medications,
[1:34] SPEAKER_00: Humira,
[1:35] SPEAKER_00: the TNF blockers,
[1:36] SPEAKER_00: things like that,
[1:37] which are very challenging meds because there's not a specific
[1:40] biomarker to sort of
[1:41] SPEAKER_00: follow.
[1:42] SPEAKER_00: You have to just sort of see how someone's doing over weeks and months.
[1:46] I think the thing that really helped her in addition to that
[1:49] was a very restrictive diet.
[1:52] It was anti-inflammatory,
[1:54] but even more than that,
[1:55] it was just a very restrictive diet.
[1:57] So she pared everything down to just basic white rice and baked
[2:02] chicken for a while
[2:03] SPEAKER_00: and then slowly started to add things back in.
[2:06] SPEAKER_00: And that ended up really working for her.
[2:11] SPEAKER_00: I don't know,
[2:11] SPEAKER_00: again,
[2:12] SPEAKER_00: if it was TNF,
[2:13] SPEAKER_00: tumor necrosis factor levels that went down,
[2:15] SPEAKER_00: or if it was another inflammatory mediator.
[2:18] SPEAKER_00: Again, we don't measure these things.
[2:20] SPEAKER_00: But what I did know is that she felt better,
[2:22] SPEAKER_00: she looked great,
[2:23] SPEAKER_00: and she started to become more active again.
[2:25] SPEAKER_01: That's fantastic.
[2:27] SPEAKER_01: And it emphasizes how these lifestyle factors,
[2:31] SPEAKER_01: like an anti-inflammatory diet,
[2:33] SPEAKER_01: and also you,
[2:34] SPEAKER_01: of course,
[2:34] SPEAKER_01: get into sleep.
[2:35] SPEAKER_01: how important that is to deal with this pain.
[2:38] SPEAKER_01: And then you have a very refreshing outlook about coping,
[2:43] SPEAKER_01: dealing,
[2:43] SPEAKER_01: managing pain,
[2:45] SPEAKER_01: which,
[2:46] SPEAKER_01: of course,
[2:46] most people think it's rooted at the site of injury or where
[2:50] the pain is felt,
[2:51] SPEAKER_01: where obviously it's the master control center at the brain.
[2:56] SPEAKER_01: And that gets us to, before I get into the new approaches and new
[3:01] SPEAKER_01: everything here, which is so great about your book.
[3:05] SPEAKER_01: One other personal story about your 82-year-old mother.
[3:09] Can you just give us the skinny on how she emerged from having
[3:15] a really bad back injury?
[3:18] SPEAKER_00: Yeah.
[3:19] SPEAKER_00: My mom's a perfectly healthy woman,
[3:22] SPEAKER_00: very active,
[3:22] SPEAKER_00: and she had a pretty innocuous sort of fall,
[3:25] SPEAKER_00: seemingly,
[3:26] where she sort of fell into a sitting position while rolling
[3:29] her suitcase one day
[3:30] SPEAKER_00: and had pretty sudden onset back pain.
[3:34] SPEAKER_00: She thought it would get better.
[3:35] SPEAKER_00: It didn't.
[3:36] SPEAKER_00: She ended up getting imaging and it showed a
[3:40] SPEAKER_00: It's called a compression fracture.
[3:42] SPEAKER_00: So the vertebrae is like these blocks,
[3:44] SPEAKER_00: one on top of the other,
[3:45] SPEAKER_00: and one of them was sort of crushed down.
[3:47] So just lost a lot of height in what's called the L1,
[3:52] the top of the lumbar spine.
[3:54] SPEAKER_00: And she had terrible, terrible pain.
[3:58] SPEAKER_00: And, you know, I was already working on the book at that time.
[4:01] SPEAKER_00: And so I was very primed to think about these things.
[4:05] But I don't think even I realized how much chronic pain just
[4:09] hijacks your entire identity.
[4:12] SPEAKER_00: Um,
[4:13] SPEAKER_00: that's the thing,
[4:13] SPEAKER_00: you know,
[4:14] SPEAKER_00: you get diabetes or cancer and these are obviously terrible diseases,
[4:17] but you may not know looking at someone on the street that they
[4:20] have that with
[4:21] SPEAKER_00: chronic pain.
[4:22] SPEAKER_00: It's, it's your entire life.
[4:24] SPEAKER_00: Um,
[4:24] SPEAKER_00: and I,
[4:24] SPEAKER_00: I mean,
[4:25] SPEAKER_00: I've,
[4:25] SPEAKER_00: you know,
[4:25] SPEAKER_00: it's my mom,
[4:26] SPEAKER_00: I obviously felt terrible for what was happening.
[4:29] SPEAKER_00: Um,
[4:29] SPEAKER_00: and I,
[4:29] SPEAKER_00: and I asked her the question,
[4:30] SPEAKER_00: which is a ridiculous question now in retrospect,
[4:33] SPEAKER_00: but you often want to ask how bad does it hurt?
[4:37] SPEAKER_00: And, um,
[4:38] SPEAKER_00: And,
[4:38] SPEAKER_00: you know,
[4:38] SPEAKER_00: then you say,
[4:39] SPEAKER_00: well,
[4:39] SPEAKER_00: on a scale of one to 10 or,
[4:41] SPEAKER_00: you know,
[4:41] SPEAKER_00: point to a frowny face versus a smiley face.
[4:43] And all those are sort of ridiculous assessments now that I've
[4:46] gone through this personally.
[4:49] And she basically said to me,
[4:51] if this pain continues,
[4:52] I just don't want to live anymore.
[4:53] SPEAKER_01: Right, right.
[4:54] SPEAKER_00: So my pain on a scale of 1 to 10 is I don't want to live anymore.
[4:59] SPEAKER_00: That's the answer.
[5:00] SPEAKER_00: She ended up doing well.
[5:01] SPEAKER_00: She got a procedure known as a kyphoplasty,
[5:04] which is a more minimally invasive procedure where they
[5:08] basically put a needle
[5:09] SPEAKER_00: through the skin,
[5:11] SPEAKER_00: through the back,
[5:12] SPEAKER_00: a thing called the pedicle,
[5:14] SPEAKER_00: which connects the back of your spine to the front of your spine,
[5:16] SPEAKER_00: and
[5:17] SPEAKER_00: and into that crushed bone.
[5:18] SPEAKER_00: And then they blow it up with the balloon to sort of restore the height.
[5:22] SPEAKER_00: And then they put in a dollop of this substance,
[5:24] SPEAKER_00: which hardens into cement,
[5:27] SPEAKER_00: sort of create an internal cast.
[5:29] And I got to tell you,
[5:31] we weren't sure whether it was going to work in terms of her
[5:34] pain.
[5:35] SPEAKER_00: But right away,
[5:37] SPEAKER_00: her pain went from,
[5:38] SPEAKER_00: I want to die to a two or three out of 10,
[5:41] SPEAKER_00: which was pretty incredible.
[5:43] SPEAKER_01: Well, it helps to have a great neurosurgeon on that one, especially.
[5:48] SPEAKER_01: Oh, my goodness.
[5:49] SPEAKER_01: I assume you weren't part of that procedure.
[5:52] SPEAKER_01: No.
[5:53] SPEAKER_01: Right, right.
[5:54] SPEAKER_00: No, that would have been an ethical thing.
[5:56] SPEAKER_00: Although,
[5:56] SPEAKER_00: you know,
[5:57] SPEAKER_00: I wanted to be right there,
[5:58] SPEAKER_00: you know,
[5:58] SPEAKER_00: to make sure they were taking good care of hers and walking that line.
[6:01] SPEAKER_01: If anybody knows about operating on the spine, you would be the one.
[6:04] SPEAKER_01: Now,
[6:05] SPEAKER_01: getting into some of the new stuff here,
[6:08] SPEAKER_01: it used to be rice,
[6:10] SPEAKER_01: and now it's meat,
[6:12] SPEAKER_01: the acronyms.
[6:14] SPEAKER_01: Can you run through that one?
[6:16] SPEAKER_00: Yeah, this is a fascinating backstory.
[6:18] SPEAKER_00: I'll tell you real quick.
[6:19] SPEAKER_00: You'll appreciate it.
[6:19] So I'm working on this book,
[6:21] and I'm really interested in the role of inflammation overall.
[6:25] And I came across this study that was done by these researchers
[6:28] who were trying to
[6:28] SPEAKER_00: answer the question,
[6:29] SPEAKER_00: who is most likely to develop chronic pain?
[6:32] And they define chronic pain as lasting three months or longer
[6:35] every day or six
[6:37] SPEAKER_00: months every other day or so.
[6:39] SPEAKER_00: And they were measuring inflammation levels.
[6:42] SPEAKER_00: And the finding that they had,
[6:45] SPEAKER_00: which ended up being really instructive,
[6:47] was the people who had the lowest levels of inflammation at the
[6:50] time of injury were
[6:52] SPEAKER_00: the most likely to have chronic pain.
[6:56] SPEAKER_00: And I had to think, I had to absorb that for a second.
[6:58] So low levels of inflammation at the time of injury were more
[7:02] likely to lead to chronic pain.
[7:04] And I think for a lot of people,
[7:06] they think of that absolutely backwards.
[7:08] Like if you're really inflamed at the time of injury,
[7:10] this is just going to be worse.
[7:11] SPEAKER_00: It's going to last longer.
[7:12] SPEAKER_00: And they found almost the opposite to be true.
[7:15] SPEAKER_00: And then they started to extrapolate that thinking.
[7:17] Well,
[7:18] look,
[7:18] what do we do when someone has an injury,
[7:20] like you sprain your ankle or something?
[7:22] SPEAKER_00: You rest it, you ice it, you compress it, and you elevate it.
[7:26] SPEAKER_00: That's right.
[7:28] All those things are designed to decrease blood flow,
[7:31] decrease inflammation,
[7:32] and
[7:33] And we just learned that if you have low inflammation,
[7:36] you're more likely to have chronic pain.
[7:38] SPEAKER_00: So then they started to say, well, instead of rice, how about meat?
[7:42] SPEAKER_00: You know, coming up with clever acronyms, I guess.
[7:44] SPEAKER_00: But that stands for mobilization,
[7:46] SPEAKER_00: exercise,
[7:47] SPEAKER_00: analgesia if you need it,
[7:49] SPEAKER_00: and treatment if you need it.
[7:50] SPEAKER_00: Like if you have a broken bone, obviously you want to treat it.
[7:54] But the idea of mobilization instead of rest as a basic
[7:57] principle was really what
[7:59] SPEAKER_00: they were driving at.
[8:00] SPEAKER_00: And when you explored that research even more,
[8:02] SPEAKER_00: it was this idea that those inflammatory markers,
[8:05] SPEAKER_00: inflammatory mediators,
[8:06] SPEAKER_00: they're doing something at the site of injury.
[8:10] SPEAKER_00: And they're helping heal.
[8:11] SPEAKER_00: So even though you might get some swelling and things like that,
[8:15] SPEAKER_00: in a sense,
[8:15] SPEAKER_00: you're letting the body do its job.
[8:17] And movement is actually important because you're actually
[8:20] increasing blood flow as
[8:21] SPEAKER_00: opposed to decreasing it.
[8:23] SPEAKER_00: So again,
[8:23] SPEAKER_00: I want to be clear,
[8:24] SPEAKER_00: like if you've broken a bone or something,
[8:26] SPEAKER_00: you shouldn't be walking on it.
[8:27] SPEAKER_00: You know, you shouldn't be using it.
[8:29] SPEAKER_00: But for most people with these less significant injuries,
[8:33] SPEAKER_00: instead of decreasing inflammation at the time,
[8:36] letting the body do its job seems to be more associated with a
[8:40] decreased likelihood
[8:41] SPEAKER_00: of chronic pain.
[8:42] SPEAKER_01: Well,
[8:43] SPEAKER_01: backing that up and how we have a whole new approach,
[8:46] SPEAKER_01: for all the years,
[8:47] SPEAKER_01: people with low back pain were told to rest in bed.
[8:50] SPEAKER_01: And then random trials were done and showed, hey, you know what?
[8:53] SPEAKER_01: Mobilize.
[8:53] SPEAKER_01: You can have a whole lot quicker and more impressive recovery.
[8:57] SPEAKER_01: So it goes right along with meat instead of rice.
[8:59] SPEAKER_01: That's right.
[9:01] You know,
[9:01] one of the things,
[9:02] the new frontiers of pain management are really exciting.
[9:06] SPEAKER_01: And you get to them in the book.
[9:08] SPEAKER_01: But a fascinating story is the family of fire walkers that led to a drug.
[9:15] SPEAKER_01: I think it's Suzetogene.
[9:18] SPEAKER_01: Suzetogene.
[9:19] SPEAKER_01: Yeah.
[9:19] SPEAKER_01: Which a lot of people don't know about.
[9:21] SPEAKER_01: And it's out there.
[9:22] SPEAKER_01: So can you trace that story first?
[9:24] SPEAKER_01: Because I think it's just, you know, a gene.
[9:26] SPEAKER_00: It's an unbelievable story.
[9:27] SPEAKER_00: Yeah, yeah.
[9:29] I always say the greatest stories that we tell sort of as
[9:31] medical people are the
[9:32] SPEAKER_00: stories of the scientific process.
[9:34] SPEAKER_00: Like, how did we get here?
[9:35] SPEAKER_00: Yeah.
[9:36] SPEAKER_00: So how we got here was back in the late 90s,
[9:39] SPEAKER_00: these researchers,
[9:41] SPEAKER_00: they were introduced to this family in Karachi,
[9:44] SPEAKER_00: Pakistan of circus performers.
[9:47] SPEAKER_00: And these circus performers, they could do all kinds of things.
[9:50] They could take sharp objects and put them through their hand
[9:53] and they could walk
[9:54] SPEAKER_00: on hot coal and do all this sort of stuff,
[9:57] SPEAKER_00: which they had seen before.
[9:59] SPEAKER_00: But the difference with this particular family,
[10:01] SPEAKER_00: for instance,
[10:01] SPEAKER_00: when they were walking on hot coals,
[10:04] SPEAKER_00: was that they could feel the coals.
[10:06] SPEAKER_00: And they could feel that they were hot.
[10:08] So they had sensation and they had pretty significantly
[10:11] preserved hot,
[10:12] cold sensation.
[10:13] SPEAKER_00: What they did not have was pain.
[10:16] SPEAKER_00: That's the only thing.
[10:16] So a lot of other firewalkers,
[10:18] for example,
[10:18] they just don't feel anything.
[10:19] SPEAKER_00: They're sort of insensate or numb to it.
[10:22] SPEAKER_00: They weren't insensate.
[10:23] SPEAKER_00: So that was really interesting.
[10:25] And they found that,
[10:26] in fact,
[10:27] it was this 14-year-old boy that they first met.
[10:30] SPEAKER_00: But then it was the whole family that seemed to be able to do this.
[10:33] SPEAKER_00: They identified a gene, which they expected to find.
[10:36] SPEAKER_00: And that gene, I think, is SCN9.
[10:37] SPEAKER_00: It's a sodium channel blocker.
[10:40] So the way that we conduct signals around our body is by
[10:43] changing voltages and sodium channels.
[10:46] So this is particular sodium channel blocker that they decided
[10:49] to essentially try
[10:50] SPEAKER_00: and replicate through a medication.
[10:52] And this is Vertex Pharmaceuticals,
[10:54] which many of your listeners may know this company.
[10:57] SPEAKER_00: But basically for a quarter century,
[10:59] SPEAKER_00: they just were working on this drug,
[11:02] which was essentially trying to replicate what that gene did
[11:05] for that family in
[11:06] SPEAKER_00: Karachi,
[11:06] SPEAKER_00: Pakistan,
[11:07] SPEAKER_00: to sort of take away pain without dulling everything,
[11:12] SPEAKER_00: without making someone insensate or numb.
[11:15] and and it worked it was tested in a couple of different uh
[11:18] pain uh scenarios and
[11:20] SPEAKER_00: it just got approved uh this spring and by the way uh doc
[11:25] SPEAKER_00: There had been no new pain medications approved since 1998.
[11:29] SPEAKER_00: Celebrex was the last one.
[11:32] We approve on average about 40 to 50 new drugs a year,
[11:36] but not a single one for pain.
[11:40] SPEAKER_00: Chronic pain is the fastest growing condition in America,
[11:42] SPEAKER_00: faster than cancer,
[11:43] SPEAKER_00: diabetes,
[11:43] SPEAKER_00: and dementia.
[11:45] SPEAKER_00: And yet there were no new medical options until Jurnavax came along.
[11:48] So it's a fascinating backstory and a very,
[11:50] very needed option for patients as well.
[11:54] SPEAKER_01: You know,
[11:54] SPEAKER_01: I think it's just the beginning,
[11:55] SPEAKER_01: too,
[11:56] SPEAKER_01: because as you really nicely summarize,
[11:59] SPEAKER_01: learning from genetics is
[12:01] SPEAKER_01: pathways of having preserved sensation but without pain.
[12:06] SPEAKER_01: There's piezo receptors, these channels.
[12:09] Hopefully,
[12:09] we're going to see building on these with other really—forget
[12:13] opioids.
[12:13] Forget even the drugs we have today,
[12:16] much better drugs,
[12:17] and this is exemplifying that.
[12:19] SPEAKER_01: But also,
[12:20] SPEAKER_01: what I love about what you get into,
[12:22] SPEAKER_01: all the other ways,
[12:23] SPEAKER_01: like,
[12:23] SPEAKER_01: for example,
[12:24] SPEAKER_01: your experience at Northwell Health,
[12:27] SPEAKER_01: where they're using instead of opioids,
[12:29] SPEAKER_01: they're using combinations of drugs with no,
[12:33] SPEAKER_01: you know,
[12:34] SPEAKER_01: maybe you could just give an example of that.
[12:35] SPEAKER_01: I know you're going to have a special this weekend.
[12:38] SPEAKER_01: Yeah.
[12:38] I guess it's like a preview for that,
[12:40] which is I'm looking forward to watching it.
[12:42] SPEAKER_01: But I think you have a clip.
[12:44] SPEAKER_01: I've seen a teaser clip with the Northwell thing.
[12:47] SPEAKER_01: What was that about?
[12:48] SPEAKER_01: Yeah.
[12:49] SPEAKER_00: I think the clip you may have seen was Maimonides Hospital in Brooklyn.
[12:53] And they basically were the first hospital to create what they
[12:57] originally referred
[12:58] SPEAKER_00: to as an opioid-free shift,
[13:01] SPEAKER_00: but a better terminology would be opioid-optimized.
[13:04] SPEAKER_00: And to be clear, look...
[13:06] Opioids can have a real value,
[13:08] but at the same time,
[13:09] we've clearly overused them.
[13:10] SPEAKER_00: And that was sort of the thinking on,
[13:12] can we think of opioids as a last resort instead of a first
[13:15] resort for any pain
[13:17] SPEAKER_00: malady that comes through the ER?
[13:19] SPEAKER_00: Kidney stones, broken hip, whatever it may be.
[13:23] SPEAKER_00: And there was no necessarily new modalities that they were using,
[13:27] SPEAKER_00: but they started to do things that people have known about for some time,
[13:30] SPEAKER_00: like nerve blocks,
[13:31] SPEAKER_00: for example,
[13:32] which typically are done by anesthesiologists in preparation
[13:35] for surgery or
[13:36] SPEAKER_00: something like that,
[13:37] SPEAKER_00: but not really used in the emergency room.
[13:40] SPEAKER_00: Nerve block.
[13:41] SPEAKER_00: I saw a 76-year-old gentleman come into the ER with a broken hip,
[13:44] SPEAKER_00: broke the top of his femur,
[13:47] and got a nerve block and was lying there comfortably and was
[13:51] able to never need
[13:52] SPEAKER_00: opioids,
[13:53] SPEAKER_00: which was incredible.
[13:55] SPEAKER_00: Ketamine is another one that they're using for acute pain control.
[13:59] SPEAKER_00: And,
[14:00] SPEAKER_00: you know,
[14:01] SPEAKER_00: I'm not suggesting these are panaceas,
[14:03] SPEAKER_00: but they're as effective as giving an opioid,
[14:06] SPEAKER_00: which is what these patients would have received.
[14:08] SPEAKER_00: Yeah.
[14:09] SPEAKER_00: Another woman came in with bilateral knee pain,
[14:11] and they put virtual reality goggles on her and took her on a
[14:15] trip to a nice
[14:16] SPEAKER_00: Indonesian beach,
[14:17] SPEAKER_00: and her pain scores dropped from an 8 to a 3.
[14:20] SPEAKER_00: And again, these things have a half-life.
[14:23] It's not like they're walking out of there pain-free for the
[14:24] rest of their life,
[14:26] but they have similar half-life to the medications that they
[14:28] would have received.
[14:30] SPEAKER_00: So they're using, you know, we're such a monotherapy culture.
[14:34] SPEAKER_00: People always say, you know, do you use ibuprofen or do you use Tylenol?
[14:38] SPEAKER_00: Some of these hospitals, they're using both at the same time.
[14:41] SPEAKER_00: One of the doctors,
[14:42] SPEAKER_00: Sergey Motov,
[14:43] SPEAKER_00: he has really gotten quite expert at using IV acetaminophen,
[14:47] SPEAKER_00: IV Tylenol,
[14:48] SPEAKER_00: in addition to ibuprofen.
[14:49] SPEAKER_00: They work in different parts of the pain cascade.
[14:51] SPEAKER_00: So, you know, just all these different options from patients
[14:55] SPEAKER_00: therapies or drugs or techniques that have existed for a long time.
[14:59] But I think over the last 25 years have gotten short shrift
[15:03] because opioids have
[15:04] SPEAKER_00: sucked up all the oxygen in the room.
[15:06] SPEAKER_00: Again, it's not that opioids can't be useful.
[15:08] And I want to be careful because I know there's a lot of people
[15:11] for whom opioids
[15:12] SPEAKER_00: may be a lifesaver.
[15:14] But,
[15:14] you know,
[15:15] there's a lot of options that I think people hadn't heard of
[15:16] before.
[15:18] SPEAKER_01: Yeah.
[15:18] I mean,
[15:18] and you even go back to the ancient times and you bring in the
[15:21] studies for acupuncture.
[15:23] SPEAKER_01: Yeah.
[15:23] You know,
[15:24] there are many randomized studies for acupuncture that can help
[15:26] people too.
[15:28] SPEAKER_01: So this is what I love about the book is that it's very comprehensive.
[15:32] I mean,
[15:32] you get into treatment for trigeminal neuralgia,
[15:35] which is like the worst pain.
[15:37] SPEAKER_00: That's the worst.
[15:38] SPEAKER_01: And now we have a way to get to that, right?
[15:40] SPEAKER_01: Without...
[15:42] Yeah,
[15:42] there are all sorts of different options now for these types of
[15:48] pain.
[15:48] SPEAKER_00: And what is interesting,
[15:49] SPEAKER_00: going back to this monotherapy sort of culture,
[15:53] SPEAKER_00: you know,
[15:53] SPEAKER_00: we call these drugs,
[15:55] SPEAKER_00: you know,
[15:55] SPEAKER_00: antidepressants or anti-epileptic drugs.
[15:58] SPEAKER_00: And I think as a result, doctors may just use them for those indications.
[16:04] SPEAKER_00: But then you come to find out,
[16:06] SPEAKER_00: for example,
[16:06] SPEAKER_00: with trigeminal neuralgia or tic de la rue,
[16:10] SPEAKER_00: using nerve stabilizers can be really helpful.
[16:13] SPEAKER_00: Surgery can be helpful in that case as well.
[16:16] But there's all these various options to basically try and
[16:18] address that particular
[16:19] SPEAKER_00: nerve,
[16:20] SPEAKER_00: the trigeminal nerve,
[16:21] SPEAKER_00: to try and alleviate people's pain.
[16:23] SPEAKER_00: That is probably the worst pain.
[16:26] SPEAKER_00: When I ask pain doctors all over the country,
[16:29] SPEAKER_00: what do you think causes the worst pain in a human being?
[16:33] SPEAKER_00: That idea of lancinating pain,
[16:35] SPEAKER_00: lightning bolt pain in your face that seemingly comes out of nowhere,
[16:38] SPEAKER_00: and you can't even chew on that side of your mouth,
[16:41] SPEAKER_00: can't brush your teeth,
[16:43] SPEAKER_00: all of that,
[16:44] SPEAKER_00: that's the sort of pain that they're trying to address.
[16:47] SPEAKER_01: Yeah,
[16:47] SPEAKER_01: no,
[16:48] I think it's impressive how you've talked to so many pain
[16:52] experts and physicians
[16:53] SPEAKER_01: today.
[16:54] SPEAKER_01: you know, around the country, they're all in the book.
[16:56] I mean,
[16:57] it's not like,
[16:57] you know,
[16:58] this is not a research project without lots of expert input.
[17:04] SPEAKER_01: So another really good dimension here.
[17:07] Now,
[17:08] one of the concerns that you get into is about this because
[17:12] it's in the brain.
[17:14] SPEAKER_01: And I think it was kind of the last thing I want to just touch on.
[17:18] SPEAKER_01: Doctors are often dismissive of pain because it's subjective.
[17:22] SPEAKER_01: And because you're giving agency to people to manage their pain,
[17:26] SPEAKER_01: it's them that,
[17:28] SPEAKER_01: you know,
[17:28] SPEAKER_01: really have control over this to an extent.
[17:32] SPEAKER_01: There's a worrisome here.
[17:35] SPEAKER_01: And a worry, that is, that, you know, this all-in-your-head issue.
[17:38] Maybe you can just touch on that because some people could get,
[17:41] you know,
[17:41] off track.
[17:43] SPEAKER_00: Yeah,
[17:43] I'm really glad you raised this because there's nothing that I
[17:48] wrote or that I
[17:49] SPEAKER_00: think that should in any way minimize people's pain.
[17:54] SPEAKER_00: I think for a long time when this idea that, hey,
[17:57] SPEAKER_00: It's in your head.
[17:58] SPEAKER_00: People felt like they were marginalized.
[18:00] SPEAKER_00: Chronic pain patients felt like they were marginalized.
[18:03] SPEAKER_00: But at the same time, all pain is in the brain.
[18:06] SPEAKER_00: These pain receptors, they're in your body.
[18:10] They send a signal to the brain,
[18:11] and then the brain is trying to determine,
[18:14] is this serious?
[18:16] SPEAKER_00: Is this something I need to worry about?
[18:18] SPEAKER_00: Is this going to cause pain?
[18:20] SPEAKER_00: And to make that decision,
[18:22] SPEAKER_00: not only do they take the information from those nociceptors,
[18:25] SPEAKER_00: those pain receptors,
[18:27] SPEAKER_00: But they look at your overall life.
[18:29] SPEAKER_00: I mean, have you experienced that before?
[18:31] SPEAKER_00: If so, what was that like?
[18:32] SPEAKER_00: Do you have depression?
[18:33] SPEAKER_00: Do you have anxiety?
[18:34] SPEAKER_00: Do you have poor sleep?
[18:36] SPEAKER_00: What's your diet like?
[18:37] SPEAKER_00: What's the weather like outside?
[18:39] SPEAKER_00: Pain is a sensory, emotional experience.
[18:43] SPEAKER_00: Both.
[18:44] SPEAKER_00: And they added the word emotional into this not that long ago.
[18:47] SPEAKER_00: And as Robert Jensen,
[18:48] SPEAKER_00: who's a doc at Mayo Clinic,
[18:50] SPEAKER_00: said to me,
[18:51] SPEAKER_00: chronic pain never occurs in isolation.
[18:54] SPEAKER_00: It always occurs with baggage attached.
[18:57] SPEAKER_00: And again,
[18:57] SPEAKER_00: I don't want people to hear that and feel like,
[18:59] SPEAKER_00: oh,
[18:59] SPEAKER_00: now you're saying it's because of my depression.
[19:02] SPEAKER_00: Pain can cause depression, but depression can also cause pain.
[19:06] But I think the point and the message that I really took away
[19:08] from that was you
[19:11] SPEAKER_00: have to address both.
[19:13] SPEAKER_00: Acute pain is one thing.
[19:14] SPEAKER_00: Someone has a trauma or something like that, that's different.
[19:17] But when the pain is lasting for a while,
[19:21] it always comes with baggage attached.
[19:23] SPEAKER_00: Maybe the pain is causing that baggage.
[19:25] SPEAKER_00: Maybe the baggage is exacerbating that pain.
[19:27] SPEAKER_00: But you have to address both.
[19:30] SPEAKER_00: And in the past, you know, I'm not the first person to say this.
[19:32] SPEAKER_00: People like John Sarno,
[19:33] they sort of alluded to this and his very provocative writings
[19:36] about psychosomatic
[19:37] SPEAKER_00: issues and back pain.
[19:39] SPEAKER_00: This isn't to marginalize or minimize pain,
[19:41] but it is to highly recommend that people think about what else
[19:45] could be driving
[19:46] SPEAKER_00: their chronic pain other than the sort of obvious thing.
[19:49] SPEAKER_00: And if you do that,
[19:51] you're much more likely to get relief and that's why i titled
[19:55] the book what i did
[19:56] it doesn't have to hurt if i had to add a sentence to the back
[19:59] of the title i would
[20:00] have said it doesn't have to hurt as long or as bad everyone's
[20:05] going to have pain
[20:05] SPEAKER_00: in their life but it doesn't have to hurt as long as or as bad
[20:09] SPEAKER_01: Well, the message here is clear.
[20:11] SPEAKER_01: You're giving a lot of hope to a lot of people,
[20:14] SPEAKER_01: like almost a fourth of people that are suffering from some chronic pain.
[20:18] SPEAKER_01: And this book was really fulfilling an unmet need.
[20:22] It's so optimistic about where this field is headed,
[20:25] how it's changed drastically.
[20:27] So thanks,
[20:28] Sanjay,
[20:28] for taking the time to give us the skinny on what's in the
[20:32] book.
[20:32] I'm sure it's going to be a big success,
[20:35] and I'm looking forward to watching the video.
[20:38] SPEAKER_01: Is it Saturday or Sunday on CNN?
[20:40] SPEAKER_00: Sunday night.
[20:41] SPEAKER_00: Sunday night, yep.
[20:42] SPEAKER_01: Well,
[20:42] everybody stay tuned for that because I'm sure that's going to
[20:45] be another way to
[20:47] SPEAKER_01: get the message.
[20:48] SPEAKER_00: Eric, I'm a great admirer of yours.
[20:50] SPEAKER_00: I don't know how you do it.
[20:52] SPEAKER_00: You obviously read the book.
[20:54] SPEAKER_00: I mean,
[20:54] you're on the West Coast and I'm reading your writings at six
[20:57] o'clock in the
[20:57] SPEAKER_00: morning,
[20:58] SPEAKER_00: my time.
[20:58] SPEAKER_00: And I'm thinking, when did he do this?
[21:00] SPEAKER_00: I just,
[21:01] SPEAKER_00: for years,
[21:01] SPEAKER_00: your energy and your constant contributions,
[21:05] SPEAKER_00: important contributions to the dialogue are,
[21:08] SPEAKER_00: I just want to say,
[21:09] SPEAKER_00: I really value it.
[21:10] I know I speak for a lot of people when I say that,
[21:11] but I really value it.
[21:13] SPEAKER_00: I look to you for everything and I appreciate it very much.
[21:16] SPEAKER_01: Well, Sanjay, thanks so much.
[21:18] And we're sorry that we got started a little bit late,
[21:20] but I think it was a fun conversation.
[21:22] And I think very appreciative of our ability to talk about such
[21:27] an important topic today.
[21:29] SPEAKER_01: Thanks, Sanjay.
[21:30] SPEAKER_01: You got it, sir.
[21:31] SPEAKER_01: Talk soon.
[21:32] SPEAKER_01: Okay.
[21:33] SPEAKER_01: Bye-bye.

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