The Mel Robbins PodcastFeel Better Now: Neurosurgeon Reveals the New Science of Healing Your Body & Stopping Pain Today
EVERY SPOKEN WORD
135 min read · 26,635 words- 0:00 – 3:08
Meet the Guest
- SGDr. Sanjay Gupta
Most people are gonna have pain at some point in their lives. But this idea that it has to become chronic pain, that it has to last, that is where the intervention can occur, and I think we haven't spent much time talking about this.
- MRMel Robbins
Today on The Mel Robbins Podcast, we're gonna learn the exciting new science about how to heal your body, how to live pain-free, how to feel better now from world-renowned neurosurgeon Dr. Sanjay Gupta.
- SGDr. Sanjay Gupta
Chronic pain is now the fastest growing condition in the United States. Faster than dementia, faster than diabetes, faster than cancer. Somewhere between one in five and one in four people in the United States.
- MRMel Robbins
Really?
- SGDr. Sanjay Gupta
So you're talking over 50 million adults are dealing with chronic pain.
- MRMel Robbins
What is the difference between acute pain and chronic pain?
- SGDr. Sanjay Gupta
So acute pain is pain that you might feel in the moment, you know?
- MRMel Robbins
Okay.
- SGDr. Sanjay Gupta
Touch hot pan. Hot. Move your hand away. Chronic pain is when it just lasts. So there's no ongoing insult or injury to your body, and yet the pain persists. Pain is the most mysterious sensation that we human beings experience. You've got to treat it that way. I'm saying this as a neuroscientist, but all pain is in the brain. That, I don't want that to sound minimizing, okay? But that is where pain is. Pain is in the brain. If your brain doesn't decide you have pain, then you don't have pain. I think the evidence is very clear now that if you're not optimized in your own life, your pain is gonna be worse for the exact same injury. There's options out there. There's hope.
- MRMel Robbins
Hey. It's your friend Mel, and welcome to The Mel Robbins Podcast. Please help me welcome the extraordinary Dr. Sanjay Gupta to The Mel Robbins Podcast.
- SGDr. Sanjay Gupta
I've been really looking forward to this, Mel. I'm a huge fan of yours, a huge fan of the show, and honored that you'd have me. Thank you.
- MRMel Robbins
Of course. And I am excited to see you after we were colleagues and friends at CNN. I am proud of the work that you're doing. I'm so excited for your new New York Times best-selling book, It Doesn't Have to Hurt. We're gonna talk all things about living a pain-free life based on the research and the science, and I'd love to start by having you tell me what could be different about my life if I take into account everything that you're about to teach us today.
- SGDr. Sanjay Gupta
Most people are gonna have pain at some point in their lives. Um, but this idea that it has to become chronic pain, that it has to last, that is where the intervention can occur, and I think we haven't spent much time talking about this. People develop acute pain, and for some reason, it, it persists.
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
It's like this memory loop just keeps getting played over and over in their brains, and I think we've learned a lot over the last decade about how to prevent that from happening. So not letting acute pain, which most people are gonna experience, turn into chronic pain. If I had to add a, a more to the title of the book-
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
... you always want longer titles, I would say it doesn't have to hurt as much or as long.
- MRMel Robbins
Oh,
- 3:08 – 9:30
What is Chronic Pain?
- MRMel Robbins
I love that. What is the difference between acute pain and chronic pain? Just for somebody like me who's not a medical doctor.
- SGDr. Sanjay Gupta
Yeah, so, so acute pain is pain that you might feel in the moment, you know?
- MRMel Robbins
Okay.
- SGDr. Sanjay Gupta
Touch hot pan. Hot. Move your hand away.
- MRMel Robbins
Okay.
- SGDr. Sanjay Gupta
Stubbed toe. Chronic pain is when it just lasts. So there's no ongoing insult or injury to your body, and yet the pain persists. People, they, they try and put a timeframe on it.
- MRMel Robbins
Uh-huh.
- SGDr. Sanjay Gupta
So they say if you have pain like that every day for three months, at that point it's considered chronic pain.
- MRMel Robbins
Okay.
- SGDr. Sanjay Gupta
If you have it sort of every other day for six months, you know, you sort of get the idea, but it's pain that just, just simply won't go away.
- MRMel Robbins
Dr. Gupta, could you give us a quick list of just things that might be considered chronic pain?
- SGDr. Sanjay Gupta
I think if you go literally from head to toe, I think headaches such as migraine headaches, that'd be considered a type of chronic pain. That's a big percentage. Going into the face, there are people who have facial pain, like trigeminal neuralgia and TMJ. Most joints can be a source of chronic pain, going from your shoulders, your elbows, your hips, your knees, down to your ankles. And then there's the back and the neck, which I think are big sources of chronic pain. So it's typically areas of the body which are moving a lot, but now you're not moving 'cause you're in pain, or things like headaches.
- MRMel Robbins
And how many people struggle with this? 'Cause I, I, I found the research really surprising 'cause I think you hear the word chronic pain and you're like, "Oh, that's for old people."
- SGDr. Sanjay Gupta
No, you know, I gotta tell you, Mel, it, it was so interesting because I first talked to my publisher about this and I thought, "How big a problem is this really?"
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
I'm a neurosurgeon so I'm seeing pain all the time.
- MRMel Robbins
Right.
- SGDr. Sanjay Gupta
But I thought I was seeing a very select, you know, sort of segment of the population. It's about somewhere between one in five and one in four people in the United States.
- MRMel Robbins
Really?
- SGDr. Sanjay Gupta
So you're talking over 50 million adults are dealing with chronic pain.
- MRMel Robbins
Meaning every day for more than three months-
- SGDr. Sanjay Gupta
Every day.
- MRMel Robbins
... they're feeling pain?
- SGDr. Sanjay Gupta
Every day for more than three months, and for many of them, decades. So three months is sort of the minimum, but when I started, you know, really researching this book and talking to so many patients with pain, it is a daily negotiation for them every day. Like, you wake up and you may think, "I have a little bit of ache and pain here and there," but everyday pain is sort of the, the, the biggest driving force in their life.
- MRMel Robbins
Huh.
- SGDr. Sanjay Gupta
They wake up with it. They go to sleep with it. They think about it all day. If they have a conversation with somebody in their life, they're probably gonna talk about their pain. Um, so it's, it's, uh, for about 17 million people, it completely interferes with their, their ability to conduct their lives, so they are in- unable to hold down jobs, go to school, you know, have terrible relationships, all these things. It is, it is really awful, and I have to say, I was, I was stunned, even as someone who, who sort of works in that field, the magnitude of pain that we have in the United States, and frankly, many countries around the world.
- MRMel Robbins
You know, one of the things I also wanted to ask you though is that for somebody that doesn't wake up every day and experience chronic pain, or doesn't...... have that kind of nagging sensation. Why is it important-
- SGDr. Sanjay Gupta
Mm.
- MRMel Robbins
... to listen to and watch this and learn from you today?
- SGDr. Sanjay Gupta
One, one of the things I think we really have to be mindful of is that chronic pain is now the fastest growing condition in the United States. Faster than dementia, faster than diabetes, faster than cancer. I mean, th- the numbers, again, are mind-boggling. So my point being that this is growing.
- 9:30 – 16:59
How to Use Your Mind to Control Pain
- SGDr. Sanjay Gupta
remarkable.
- MRMel Robbins
So is it also true that if the amount of pain and the unpleasantness that you feel varies day to day based on how you're feeling, conditions that may or may not be under your control, is it also true that if you look at those and you focus on a more holistic approach, it's also the solution to minimizing chronic pain that you feel?
- SGDr. Sanjay Gupta
I, I, I think so. I, I think that that, that is where the science is headed.
- MRMel Robbins
Wow.
- SGDr. Sanjay Gupta
That you, you should start thinking of chronic pain much in the same way that you think of any other chronic disease. You're trying to avoid diabetes. You're trying to avoid heart disease. People would not put pain necessarily in that same category, right?
- MRMel Robbins
I wouldn't.
- SGDr. Sanjay Gupta
'C- 'cause you think of it just purely like a physical sort of sensation.
- MRMel Robbins
Yes.
- SGDr. Sanjay Gupta
But I think we're starting to understand that pain is really affected by all these different things in the body, much like many of these other chronic diseases are. So if you're optimizing your life, and, you know, some of it is very tangible stuff. If you decrease inflammation in your body overall, then a- an injury is less likely to hurt as much, because you're not sort of harnessing as much inflammation, over-inflammation to it. If you're, if you're physically active, if you're doing all the things to, to keep your body and your muscles and your tendons strong, you're not likely to hurt as much.
- MRMel Robbins
Hm.
- SGDr. Sanjay Gupta
We kinda get that. But the idea that if you don't have depression, something wouldn't hurt as much, this is more of a revelation.
- MRMel Robbins
Wow.
- SGDr. Sanjay Gupta
One of the doctors I interviewed for the book said this quote to me, which really stuck with me, and the quote was, "Chronic pain hardly ever occurs in isolation. It always comes with baggage attached." Now, baggage, I don't mean this in a pejorative way, but baggage could be all kinds of things. It can, again, be depression, anxiety, poor sleep. You have to address the baggage as much as you address the pain.
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
And if you look at good pain doctors, I visit to a lot of pain clinics, I mean, they have psychologists on staff. And many times, it's the psychologist that is the first person to see that patient.
- MRMel Robbins
Why?
- SGDr. Sanjay Gupta
Because that baggage is the one thing that probably no one else has addressed, 'cause they get pain medications. They may get procedures. They're always trying to treat the chronic pain like an acute pain, like an immediate pain.
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
But now it has all this baggage attached to it. If you don't address the baggage, you're probably never going to be able to actually fully address the pain. And, you know, look, this is a provocative area in pain medicine, and there has been these authors before me, like John Sarno, who anybody who knows, reads about pain will know that name because he wrote a book about back pain. And he sort of really championed this idea of psychosomatic.
- MRMel Robbins
Yes.
- SGDr. Sanjay Gupta
And, you know, in his New York Times obituary, there was some line in there that said something like, "Half the country thought this guy was a prophet, and half the country thought he was a pariah." Because the idea of saying, "Hey, look, your brain is deciding this, uh, all these different things play a role," some people thought, "You're minimizing my pain."
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
You're mar- you're, you're marginalizing folks who are in chronic pain. I don't think that was his intent. It's certainly not my intent. But at the same time, this idea that, yeah, a psychologist maybe should be involved in dealing with your chronic pain, because there's that baggage attached. And that baggage, by the way, is a two-way relationship. If you have more baggage, more pain. If you have more pain, if you have more baggage. I think, I think sleep is a really good example. A lot of people I talked to for the book said, "I'm not getting good sleep because of my pain."
- MRMel Robbins
Mm. Well, that makes sense.
- SGDr. Sanjay Gupta
That makes sense, right?
- MRMel Robbins
And it's sort of like a chicken and an egg thing.
- SGDr. Sanjay Gupta
That's the thing.
- MRMel Robbins
Do you have pain because you're not getting sleep? You don't sleep because you have pain.
- SGDr. Sanjay Gupta
That's right. That-
- MRMel Robbins
So how do you untangle that knot?
- 16:59 – 23:38
The Future of Pain Medicine
- MRMel Robbins
what are you, Dr. Gupta, excited about, after doing all this research for this new best-seller, that you've learned about the kind of frontier of science and how we can think differently about pain and think differently about treating it and relieving people of it?
- SGDr. Sanjay Gupta
I, I think there's two sort of broad areas that I'm really excited about. One is, you know, high-tech, innovative work that is happening, which, as a neuroscientist, was really mind-blowing for me. And I've been in this world (laughs) for 25 years, so I learned a lot. But I think the, the second thing is because opioids sort of sucked up all the oxygen in the room for 25 years-
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
... you had opioids for everything, kidney stone, dental procedure, hip fracture, everything was treated with an opioid. As a result, all these other modalities, some of which are not new, some of which are quite old actually, got short shrift. They just were not utilized, uh, for things.
- MRMel Robbins
What are some of those modalities?
- SGDr. Sanjay Gupta
So, if somebody comes into the emergency room with a hip fracture, which is a really common problem, especially as people get older-They almost assuredly would get opioids. Now, in many ERs around the country, they're giving nerve blocks. So it takes about 10- 10 minutes, and they're essentially numbing up the area around the hip and giving this nerve block. Helps with pain immediately. Pain scores drop to zero. But also, it obviates the need or prevents the need for opioids going into the future. They don't need opioids after that. They've- they've gotten rid of that acute pain syndrome.
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
When I was in this emergency room in Brooklyn, Maimonides, which is this really cool place, by the way. It's- it's a level one trauma center, super diverse. They speak 120 languages there, and they are championing what they refer to as opioid optimized ERs, which is not to say opioid free, because opioids can still play a role, but they will use opioids as a last resort instead of a first resort. But they were using virtual reality. So I had-
- MRMel Robbins
How does that help with pain?
- SGDr. Sanjay Gupta
There was a 76-year-old woman who came in with terrible knee pain, bad enough to take her to an emergency room in the middle of the day, which, you know, that's- that's a big ask of somebody, right? It's your whole day. And they put on virtual reality goggles, 20 minutes, took her to a nice Indonesian beach somewhere, and her pain scores dropped from about an eight to a three. How does it work? Some-
- MRMel Robbins
What's your theory?
- SGDr. Sanjay Gupta
People al- often say it's distraction. I think it's probably some component of distraction from the pain. Um, but I think it's also leaning into this idea that we do truly have this integrated system. If you are on an Indonesian beach, your stress levels are probably dropping. You're probably releasing more of the feel-good hormones. You're activating something in your body known as your endogenous opioid system.
- MRMel Robbins
What is that?
- SGDr. Sanjay Gupta
It is our body making opioids. You know, the opioid pills that you take, like many things in medicine, got their inspiration from the human body. So many of the things that we do in medicine take our inspiration from the human body. But let me tell you the big difference between the opioids you make versus the oio- opioids you take. Opioids you take, like pills and stuff like that, they may decrease pain, but they may also enhance memory, okay? So they actually, in some ways, are forcing you to remember that experience or remember that pain, sort of creating that memory loop around pain, and they also decrease mood. You know, after a while, if you're ever talking- if you- if you've ever spoken to an opioid addict, they're at some point not taking opioids to get high.
- MRMel Robbins
Hm.
- SGDr. Sanjay Gupta
They're taking it to not feel terrible.
- MRMel Robbins
Hm.
- SGDr. Sanjay Gupta
Right? To- to- to feel some sense of normalcy again. So point being that opioids decrease mood. They- they increase memory in a bad way, meaning making you remember the painful experience, even as they decrease pain. But your own natural opioids also decrease pain. They decrease or inhibit memory of the painful experience, and they improve mood. It- it- it's- it's remarkable to me. So you ask, what is the mechanism of something like virtual reality goggles, or frankly, a lot of these modalities? In some ways, they're letting the body do its job, and they're helping it along the way. It's your own endogenous opioid system that we're just trying to- just trying to give it a little- a little push, a little nudge, you know, sort of make it work. And if you can get it working, it's- it's fantastic.
- MRMel Robbins
I personally think it's very exciting to be reminded that even if you're somebody that is experiencing chronic pain right now, or you have somebody that you love in your life who is, that even if it's from an acute injury, even if it's from an old injury, even if it's been nagging around for a while, that your body is designed, it has this incredible intelligence to it, to have you forget the pain.
- SGDr. Sanjay Gupta
Mm.
- MRMel Robbins
What you're here to suggest is that there are really exciting things to consider that both help your body feel less pain, but also help your body release these natural healing things that we haven't been talking about.
- SGDr. Sanjay Gupta
That's right. That's right.
- MRMel Robbins
Are there ways at home that, if you don't have a VR set, that you could extrapolate this exciting research and stimulate the res- release of that, I can't even remember what, natural something something system?
- SGDr. Sanjay Gupta
Yeah. There- there are lots of things that we can do. A lot of people refer to this whole endogenous opioid system as- as a component of the placebo effect, right?
- MRMel Robbins
It doesn't sound like a placebo.
- SGDr. Sanjay Gupta
Well-
- MRMel Robbins
It sounds like it's working.
- SGDr. Sanjay Gupta
Yeah, but placebos can work.
- MRMel Robbins
Okay.
- SGDr. Sanjay Gupta
That's the thing, is that, you know, you ha- e- everything gets tested against the placebo. And people have often asked, "I- I gave that person a sugar pill, and yet they improved. Like, how could that possibly be?" It's not the sugar pill, obviously. It's your expectation that that was going to help, and when you expect something to help, it helps. Ex- Expectations and experience are inextricably linked. If you expect something to work for your pain, it's far more likely to work. It's far more likely to change your experience. And what is at the root of that is probably this endogenous opioid system.
- 23:38 – 29:23
Why Meditation is a Powerful Tool in Managing Pain
- SGDr. Sanjay Gupta
One of the things I got really interested in, Mel, with regard to what you can do at home is meditation. I- you know, I think a lot of people hear meditation, "Yeah, sounds good. I mean, I like to meditate every now and then. It relaxes me, chills me out, whatever." Me too. Um, what I think has happened over the last decade is that these researchers have decided to really put it to the test and figure out, how do we actually test the value of something like meditation? So the- there's these researchers at UCSD, Eric Garland sort of leads this team, and they created a really fascinating experiment.... where they basically put these heating filaments on your arm, okay? I did this experiment myself. These heating filaments are hot, really hot, just to the point where you, you're not getting burned, but you're almost at that point. Like if you were touching a really hot plate, you would drop it, and these are on your arm, okay?
- MRMel Robbins
Okay.
- SGDr. Sanjay Gupta
And you sit there, pre-meditation, and they basically measure your pain scores and your unpleasantness scores, these two things. And then you go through this guided meditation, and it's a very specific meditation. It's part of something known as the MORE Protocol, which is Mindfulness-Oriented Recovery Enhancement. And you see how much did your pain scores and your unpleasantness scores drop as a result.
- MRMel Robbins
Now, are you meditating while the thing's on your arm?
- SGDr. Sanjay Gupta
You're meditating while the thing's on your arm. You meditate before, and then you continue to meditate as you start to go through the experiment.
- MRMel Robbins
What did you experience?
- SGDr. Sanjay Gupta
So numerically, I experienced a drop in my pain scores from a 7.4 to a 2, and my unpleasantness score from a 5 to a 1.8.
- MRMel Robbins
Wow.
- SGDr. Sanjay Gupta
Very significant. And that was just purely meditation. To, to give it even more context, what Eric Garland and the, his team will say is, "What else in society kind of gives you similar relief from pain and, and unpleasantness?" And the thing that they came up with was five milligrams of OxyContin. The idea that meditation could give you that sort of relief was pretty, pretty mind-numbing, I think, for a lot of people. I don't mean to suggest that that pain relief lasts forever-
- MRMel Robbins
Right.
- SGDr. Sanjay Gupta
... just like OxyContin doesn't last forever. But during the time that people meditate, they can drop their pain scores significantly, and that's just your, that's just your mind. People really aren't sure why these things work, and it, it's hard to study. But what they do know from an outcome standpoint is that these patients are getting tremendous relief. There's options out there. There's hope out there. But pain is the most mysterious sensation that we human beings experience. You've got to treat it that way.
- MRMel Robbins
Wow. What are the things that you wish people in pain knew, and what do you wish are the one or two things that you'd start doing right now? We're gonna get into, like, a lot of the protocol and, and, like, more specific stuff, but just a bit of, like, here's the North Star of what's possible. 'Cause you may be right now in a day-to-day life where you just think you're stuck with this back, or you're stuck with this knee, or you're stuck feeling like this forever.
- SGDr. Sanjay Gupta
You know, I, I preface all these conversations I have with patients, um, with, with a reminder that, look, I, I, I don't wanna say anything that's gonna minimize their pain.
- MRMel Robbins
Mm-hmm.
- SGDr. Sanjay Gupta
Because I, I, I think when I say something like, "All pain resides in the brain," I'm not at the same time saying, "It's all in your head." Those are two different things. And I'm saying this as a neuroscientist. But all pain is in the brain. That, I don't want that to sound minimizing, okay? But that is where pain is. Pain is in the brain. If your brain doesn't decide you have pain, then you don't have pain. And by the way, the flip is also true, which is the brain can decide you do have pain for no reason. People who have limbs that are missing, they have phantom limb pain. How, how could that be? Th- It's not even there anymore, and it still hurts. Or something known as chronic regional pain syndrome, which is basically pain in your hands or feet without any injury or any obvious trauma or anything. So, you know, I s- I start there often when I talk to patients, just sort of reminding them of that. That for some reason, no fault of your own, but there's this memory loop that is continuing to get replayed over and over again that's causing that pain. Let's address that in some way, um, addressing that baggage as much as you're addressing the pain. It's not... I think the, the, one of the, the questions that I think a lot of people have is, is why? Why does the body do that? Is it a glitch of our central nervous system to just keep playing those memory loops?
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
If you talk to people like Bessel van der Kolk, who wrote this great book called The Body Keeps the Score, I think what Bessel would suggest, um, is that there's something else that's probably happened in your life, and maybe you can't remember it, but the body keeps the score. And maybe by addressing some of those things that perhaps aren't in conscious awareness for you, you're not thinking about day to day, like, you're not thinking about why your, your jaw hurts.
- MRMel Robbins
Right.
- SGDr. Sanjay Gupta
You're not thinking about why that might be necessarily, trying to treat the symptom more than the cause. And you may not be able to identify the cause yourself.
- MRMel Robbins
Here's what I find super exciting about this. 'Cause, you know, when I've been in pain, I wanna defend it because-
- SGDr. Sanjay Gupta
Yeah.
- MRMel Robbins
... it feels very real. But if you could just open your mind to the possibility that maybe you don't need to fix your back or your leg or your neck, maybe that part of the solution is really addressing the memory loop that's playing in your head, that opens up a whole different possibility and an avenue of treatment and pain
- 29:23 – 37:12
The Incredible Rubber Hand Research Study That Proves We Can Fake Pain
- MRMel Robbins
relief-
- SGDr. Sanjay Gupta
Yes.
- MRMel Robbins
... that you haven't even considered. In fact, you write... I wanna read to you from your blockbuster book, It Doesn't Have to Hurt. This comes from page number nine. "The point is that the brain creates pain on cue from a vast array of stimuli, biology, psychology, social, emotional, environmental, even cultural. And just as we now understand that the brain can be nurtured, developed, and optimized at any age, there's growing evidence that the brain can also rewire-"
- SGDr. Sanjay Gupta
Mm.
- MRMel Robbins
"... itself in ways that change the neural circuitry for pain?"
- SGDr. Sanjay Gupta
Yes.
- MRMel Robbins
Really?
- SGDr. Sanjay Gupta
Yeah.
- MRMel Robbins
"Reducing its intensity or duration and potentially eliminating it altogether." So you're saying that there's growing evidence that your brain can rewire itself and change that memory loop and the neural circuitry for pain, even pain that happened a long time ago that you're still...... remembering.
- SGDr. Sanjay Gupta
Still dealing with, still remembering. Neuroplasticity, you know, which is sort of the, the, the name for this larger concept of being able to change your brain. There's this phrase, I, I think it came from, like, the n- 1940s. H- Hebbian. Hebb was the doctor who coined this. But basically, neurons that fire together, wire together. The thing about neuroplasticity that I think a lot of people don't realize is that it's not an inherently benevolent process, nor is it malevolent, nor is it bad. It's neutral. It'll kinda do whatever you ask it to do. So, if you're hyper-focused on the pain, you're firing neurons together.
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
And they're gonna wire together, and that's gonna reinforce the memory loop. What is, I think, fascinating about pain is that pain circuits travel, and they go through all these various areas. Your amygdala, which is your emotional center, it tends to be larger in patients who, who are in chronic pain. Their prefrontal cortex tends to be smaller, so their judgment and things like that tend to not be as good because their prefrontal cortex is shrunked to some extent. But it al- also goes through the hippocampus, which is your memory store, so you might start to really remember it well. Uh, your past experiences with pain, you remember those and they may amplify your current episode with pain. So, every time you start to have a twinge of pain-
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
... it's like, man, it just, like, skyrockets. It's like it just went from zero to 100 just like that. And I've seen this in patients, even, like, in real time. They'll be in my office, uh, you know, and, and they'll, they'll, you know, sort of be there and then all of a sudden, they're, they're cringing. Nothing happened to them, right? It wasn't like they fell or anything. They're just sitting there. Like, what, what is going on there? Why has, why has that suddenly gone from zero to 100 or from 10 to 100? A lot of that is because this very complicated sort of loop of, of pain circuitry, including memory.
- MRMel Robbins
Well, let me ask you a question. Just, like, even in the basics so I kinda understand this. When that object hits my foot-
- SGDr. Sanjay Gupta
Mm.
- MRMel Robbins
... right? I'm taking it, like, the skin and nerves and everything send a signal-
- SGDr. Sanjay Gupta
That's right.
- MRMel Robbins
... up to the brain-
- SGDr. Sanjay Gupta
That's right.
- MRMel Robbins
... in nanoseconds, and then your brain has to, like a super computer register-
- SGDr. Sanjay Gupta
Yes.
- MRMel Robbins
... what just happened?
- SGDr. Sanjay Gupta
Yes.
- MRMel Robbins
Why does it tell me it's painful?
- SGDr. Sanjay Gupta
Well-
- MRMel Robbins
What is the purpose of that?
- SGDr. Sanjay Gupta
I- so if it's an acute pain, it's, you know, oftentime it's to teach you a lesson. Like, "Hey, Mel-"
- MRMel Robbins
(laughs)
- SGDr. Sanjay Gupta
"... don't be a klutz. Don't drop that vase on your foot anymore." (laughs)
- 37:12 – 44:58
Why Physical Activity is Important for Pain Management
- SGDr. Sanjay Gupta
So, you know, like, uh, Rich Roll, I talked to him the other day, he- he had a very significant spine problem.
- MRMel Robbins
Oh my gosh. And he did surgery where they went in the front and the back ?
- SGDr. Sanjay Gupta
Front and the back, yes, yes. I- I- I, uh, you know, Rich is a good friend. We were talking throughout that entire process. And, you know, he's an Ultraman athlete, you know, just I think he was shocked at how much his post-op recovery sort of took. Now, one thing that Rich would say if he were here was that he'd been dealing with chronic pain really for 13 years-
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
... since 2012. And part of the reason that it took a lot longer for him to heal, and he's still not completely recovered from a pain standpoint, his pain, which was acute back in 2012, started to basically be, uh, encompassed by all this baggage that we talk about.
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
And Rich is as smart as he is and as resilient as he is, probably wasn't addressing the baggage that came with this. That idea of even a guy like him, so this should, you know, he- he's an Ultraman, he's an athlete, he's- takes great care of himself, yet he still had this because of that- that added baggage. I think now that he's addressing that more, I think in a very, very intentional way, he's starting to get relief from his pain.
- MRMel Robbins
I would love to have you just tick off, before we jump into the protocol-
- SGDr. Sanjay Gupta
Mm.
- MRMel Robbins
... that people can follow, what constitute baggage that creates a greater s- pain sensation and goes along with it, so that as you're listening on behalf of yourself or a loved one, and you may have a structural issue, you may need surgery for something, you may need physical therapy, um, but there's probably some things that are weighing you down that both increase pain and also help alleviate it and help accelerate your healing.
- SGDr. Sanjay Gupta
That's right.
- MRMel Robbins
So what is, like, the top five things of baggage that you tend to see?
- SGDr. Sanjay Gupta
Previous history of pain-
- MRMel Robbins
Okay.
- SGDr. Sanjay Gupta
... is a big one. If you've, if you've been, if you've had pain in the past, then you have a relationship with pain. And- and for many people, that amplifies a future pain experience. Depression. About 40% of people with chronic pain also have depression. Anxiety. Um, mostly untreated forms of this, but even in people who have some forms of treatment, they may still have, uh, added chronic pain. Poor sleep. That was, that was a big one. That was a big one. And again, it's a bidirectional sort of relationship.
- MRMel Robbins
Mm-hmm. Mm-hmm.
- SGDr. Sanjay Gupta
Pain it- worsens sleep, sleep worsens pain. But those are s- those are some of the big things, I think, that have always felt a little squishy in terms of the relationship to pain.
- MRMel Robbins
What about high levels of stress in your life? You mentioned depression, anxiety, um, a history of pain, which I would think makes you brace more for pain.
- SGDr. Sanjay Gupta
That's right.
- MRMel Robbins
Um, the, uh, not getting enough sleep.
- SGDr. Sanjay Gupta
The sleep, the stress, yep.
- MRMel Robbins
Stress. Is there anything else that you think is important for somebody to, like, "Okay, check, check, check, these are things that I need to look at"?
- SGDr. Sanjay Gupta
I- I think, um, certainly how we move-
- MRMel Robbins
Yep.
- SGDr. Sanjay Gupta
... how we nourish ourselves, and how we rest-
- MRMel Robbins
Okay.
- SGDr. Sanjay Gupta
... I think are- are things that are important with all chronic diseases.
- MRMel Robbins
Yep.
- SGDr. Sanjay Gupta
But especially with pain. And I think, um, the idea that, as a general rule, if you're told that you're in pain, you're told to not move-
- MRMel Robbins
Mm.
- 44:58 – 53:43
Train Your Brain to Manage Pain
- SGDr. Sanjay Gupta
- MRMel Robbins
How can you start to retrain your brain to experience pain differently? Because I feel smarter. I feel like I'm getting this.
- SGDr. Sanjay Gupta
Y- y- y- you're gonna be the best judge of how to retrain your brain, and what I mean by that is that just simply paying attention to your pain and maybe even keeping a pain journal for a period of time to sort of-
- MRMel Robbins
Wouldn't that make it worse?
- SGDr. Sanjay Gupta
Well-
- MRMel Robbins
Or does it make it better? Better because you're now starting to go, "You know what? I'm gonna stop assuming I'm in pain all the time, and I'm gonna start to notice when I'm not"? Is that what you're doing?
- SGDr. Sanjay Gupta
I think you're trying to find the things that are correlating with your pain.
- MRMel Robbins
Oh.
- SGDr. Sanjay Gupta
"Every time I talk to my mom, my back hurts a little bit."
- MRMel Robbins
(laughs) Well, that may be your mom, not mine.
- SGDr. Sanjay Gupta
No, no, my- I'm, I'm kidding, Mom. (laughs) Um, she watches your show.
- MRMel Robbins
(laughs)
- SGDr. Sanjay Gupta
So I gotta say this-
- MRMel Robbins
We love you.
- SGDr. Sanjay Gupta
(laughs)
- MRMel Robbins
You did a great job, Mom.
- SGDr. Sanjay Gupta
(laughs)
- MRMel Robbins
Um-
- SGDr. Sanjay Gupta
But n-
- MRMel Robbins
... that's gonna cause you s- you a lotta pain.
- SGDr. Sanjay Gupta
(laughs)
- MRMel Robbins
He was just kidding. Can you give me some examples of what you've seen that have a correlation to when people's pain spikes?
- SGDr. Sanjay Gupta
Yeah. So, uh, y- you know, uh, sometimes it can be, um, really obvious things. Some people are gonna hurt more in the morning. Some people are waking up in the middle of the night with their pain. Is the pain worse in the morning or at night? What things make your pain better or worse? B- besides medications, I'm talking about. "I always feel okay when I'm doing X, Y, or Z."
- MRMel Robbins
Hmm.
- SGDr. Sanjay Gupta
And starting to, to dig into, to those types of things. I, uh, you know, in the... I think the, the, the point a little bit in terms of training the brain is that no one has really been talking about this. I'm not the first, by any means. Guys like John Sarno. Uh, uh, people have done this for some time. But the idea that it has largely been ignored-
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
... looking at these other things. Maybe medications are necessary for certain things, like migraine headaches. There's new classes of medications. Neuropathic pain, that can be, you know, that sort of lancinating, terrible lightning-like pain that you get in your arm or your legs. Some of those, you may need medications. But the idea that despite those medications, you continue to have chronic pain-
- MRMel Robbins
Hmm.
- SGDr. Sanjay Gupta
... what are your triggers for that? Figuring out what those triggers are will, I think, be the first step towards training your brain. And I, I, you know, I, I don't want to over or underemphasize the value of true brain training, whether it be meditation, whether it be virtual reality. I would say look at the data. I mean, I'm not just telling you this. Um, and I was a skeptic of this. You know, I'm, I'm a neurosurgeon. I'm the guy who opens the head and, you know, does things to the brain. The idea that meditation could, could cause these changes, we now know meditation objectively and measurably changes your brain. It causes thickening in certain areas of the brain that help reduce chronic pain.
- MRMel Robbins
Hmm.
- 53:43 – 56:46
Why Does My Jaw Hurt?
- MRMel Robbins
I have TMJ, but I didn't even consider that chronic pain.
- SGDr. Sanjay Gupta
Right.
- MRMel Robbins
I- it bothered me so much, I actually got surgery on the joint 20 years ago. But as I'm sitting here-
- SGDr. Sanjay Gupta
Did that help?
- MRMel Robbins
Oh, it helped a lot, but so did the fact that I wear the bite guard. But I'm also hearing you talk and I'm like, "Well, actually, the, the more I prioritize sleep and the more that I'm moving my body and the more that I manage my stress, funny thing, I'm not grinding my jaw into the ground as much anymore and it's not as painful."
- SGDr. Sanjay Gupta
So-
- MRMel Robbins
I mean, it used to lock, Sanjay.
- SGDr. Sanjay Gupta
Really?
- MRMel Robbins
And, and you know, I'm, I'm about to turn you into our personal team doctor here and ask you a bunch of questions.
- SGDr. Sanjay Gupta
Okay. (laughs)
- MRMel Robbins
(laughs) But you know, the NIH says more than 10 million people in the US live with jaw pain.
- SGDr. Sanjay Gupta
Sure. I- I think when you look at temporal mandibular joints, so this, this joint in here-
- MRMel Robbins
Is that what TMJ is?
- SGDr. Sanjay Gupta
TMJ, exactly. Temporal mandibular joint.
- MRMel Robbins
Really? That's a mouthful.
- SGDr. Sanjay Gupta
I... (laughs) Literally.
- MRMel Robbins
Yes. (laughs)
- SGDr. Sanjay Gupta
E- eh, t- you know, for, for a lot of people, there's different reasons for it, but one thing I would say is the numbers have gone up pretty significantly over the last-
- MRMel Robbins
Oh.
- SGDr. Sanjay Gupta
... uh, couple of decades.Why would that be? We're not eating different foods necessarily. Like, why would our jaws be hurting a lot more? And I think it's... You know, it goes back to many of the same things that are driving a lot of disease in our country. Again, you think of heart disease, you think, "I'm eating too much meat." Yeah, maybe, to some extent, but there's also the stress that you live in. People who are socially isolated ha- have more heart disease.
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
What's the relationship there, even if they are healthy eaters? We find that isolation triggers pain centers in the brain. My point being that there's lots of things that could be sort of driving the TMJ, and many of the ills of our society are the same things that, uh, are driving chronic disease, drive chronic pain. So, you know, getting to the root cause, you- you clearly had some root causes with regard to the amount of stress and everything-
- MRMel Robbins
Oh, sure.
- SGDr. Sanjay Gupta
... else in your life. Um, y- your- you... I don't know if you saw someone who's a specialist to deal with that part of your life, maybe you did, but if you did, the idea that you're doing it because you wanna fix your jaw, right? "I wanna fix my pain, so I'm seeing-"
- MRMel Robbins
Oh, that's interesting.
- SGDr. Sanjay Gupta
"... a psychologist."
- MRMel Robbins
I love this paradigm shift that you would go work on your mindset-
- SGDr. Sanjay Gupta
Yeah.
- MRMel Robbins
... and work on your stress levels-
- SGDr. Sanjay Gupta
Yes.
- 56:46 – 1:08:16
How to Reduce Pain
- SGDr. Sanjay Gupta
- MRMel Robbins
I would love for you to read the dedication of this book.
- SGDr. Sanjay Gupta
Mm. For my three daughters, Sage, Sky, and Soleil, every word in this book is for you. One of our greatest fears is seeing the people we love in pain. And with this book, I hope to prevent that from happening for you. Having parents who live a pain-free life is the gift I aim to give you so that your mother and I may always be present, active, and engaged. For my dear wife, Rebecca, you, like too many others, have lived with physical pain. Yet, during those times when I felt powerless to help, you inspired me to dig deep into what is possible and put what I learned on the page. Thank you for always taking the time to listen, encourage, and offer stellar suggestions for how to make this book the best it could be. And for the millions of people out there with chronic pain, I know it presents you with profound challenges often invisible to others. I wrote this book for you to share your stories and my confidence that together we can chart a path beyond pain, a path of action, hope, and healing.
- MRMel Robbins
How has Rebecca's journey impacted you?
- SGDr. Sanjay Gupta
I mean, you know, she's my wife, you know? We've been married forever now. We've known each other for a long time. And, um, you know, I am... I've been a doctor for a long time, and I think, um, with my wife and my mom, pain came home. It came to visit my house. And, you know, I think I've always tried to treat my patients like family, but at the same time, like, watching the ones that you love and you spend all this time with so you really know them and you know how they are and you know their personalities and you see pain hijack their lives, hijack their identity, and you're like, "That's not the person I know," and you know it's pain talking, not them, I think that- that- that was... that was tough. But I think at the same time, you know, I think our greatest joys sometimes now come in overcoming things-
- MRMel Robbins
Mm-hmm.
- SGDr. Sanjay Gupta
... rising above. And I think, in some ways, not that I wish that she had gone through what she went through, just like I don't wish that you had gone through what you went through, but she's doing great.
- MRMel Robbins
How long did it take?
- SGDr. Sanjay Gupta
It took a while. I still remember when it sort of started in my mind for her, because she had sort of been talking about it but you- you keep thinking, "Oh, this is just a thing that'll go away in a little bit."
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
And she couldn't turn the doorknobs, you know, with her hand. And I thought, "Well, that seems like a very arthritic sort of component to this."
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
"Like, what i- what is happening?" And I remember lying in bed with her once and, you know, asking silly questions in retrospect like, "How much does it hurt?" Like, "Doc, how do I explain this to you? (laughs) You want me to give you a number? Because my number would be im- immeasurable, right? Y- you don't understand." Or I'd say, "Point to where it hurts." And I remember she would... she would point to a part on her body and she would basically say, "This is the only place it doesn't hurt."
- MRMel Robbins
Mm.
- SGDr. Sanjay Gupta
And- and I think that was probably, you know, three or four year journey in some ways. Keep in mind, you know, the- the way the medical establishment works, especially with these kinds of pains, is you try a medicine, in this case it may be an- a medication for autoimmune disease-
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
... and you need to give it months to see if it'll work, right? So i- it's not a fail-fast sort of model.
- MRMel Robbins
Yeah.
- SGDr. Sanjay Gupta
It's a long trial period sort of model. Maybe it's working, maybe it's not. So months would go by, didn't really work, go back to the drawing board, try something else. So, you know, that... We probably went through that cycle four or five times, six months a pop, and then now she's on no meds.
- MRMel Robbins
I am sorry that we went through this, but I'm grateful that you guys did because it clearly sparked what I think is going to be some of your most important work because it's personal-
- SGDr. Sanjay Gupta
Mm.
- MRMel Robbins
... it's impactful, and as you said, the pain came home.
- SGDr. Sanjay Gupta
Yeah.
- MRMel Robbins
But the story, which is very daunting and so many people can relate to it-... also proves that over time, all of these changes that you're talking about, that, that really galvanize the natural intelligence and desire of your body to heal and to be pain-free, they can work. And that is an incredible gift that you're giving to all of us. And so, thank you to Rebecca-
- SGDr. Sanjay Gupta
Mm-hmm.
- MRMel Robbins
... thank you to your mom, thank you to you.
- SGDr. Sanjay Gupta
Well, um, I, I really appreciate that, Mel, especially coming from you. It, it's, it's, um, you know, you write books, as you well know, and, um, you know, you, you spent three years, I spent three years working on the book. And you, you, you ... I was dreaming about it at some points, you know, just it, it takes over your life, and I wanted to learn everything I could. And had I written the book that I really wanted to write, it would probably would have been, you know, this thick, you know?
- MRMel Robbins
You wouldn't have read it.
- SGDr. Sanjay Gupta
You wouldn't have read it.
- MRMel Robbins
So I'm glad it's smaller. (laughs)
Episode duration: 1:08:16
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