Chasing Life: Beyond Smiley Faces – A New Way to Diagnose Pain
Host: Dr. Sanjay Gupta
Episode Release Date: August 8, 2025
Introduction: Rethinking Pain Assessment
In this episode of Chasing Life, Dr. Sanjay Gupta delves into the complexities of pain diagnosis and management. Traditional methods, often relying on subjective scales like the 1 to 10 pain rating or emoticon-based tools, are inadequate for capturing the true nature of an individual's pain experience. Dr. Gupta introduces listeners to groundbreaking research aimed at revolutionizing how we understand and treat chronic pain.
The Case of Ed Mowry: A Journey Through Chronic Pain
The episode begins with the story of Ed Mowry, a 51-year-old musician who has endured complex regional pain syndrome since age 15. [00:00]
Dr. Sanjay Gupta: "When Ed Mowry stepped into Dr. Prasad Srivalkar's office in 2021, he had undoubtedly answered that question hundreds of times... He described it as a sharp, stabbing burning over his entire body and he had no clear explanation why."
Ed's persistent pain had led to 25 surgeries and an inability to maintain employment, overshadowing his passion for music. Seeking relief, he turned to Dr. Prasad Srivalkar, a specialist in pain medicine at the University of California, San Francisco, renowned for his research in deep brain stimulation (DBS) therapies.
Deep Brain Stimulation: A Revolutionary Approach
Dr. Srivalkar's pioneering work focuses on using DBS to target specific areas of the brain responsible for pain perception. This method involves implanting electrodes to stimulate brain regions, potentially alleviating chronic pain where traditional treatments have failed. However, pinpointing the exact location within the brain remains a formidable challenge.
Dr. Prasad Srivalkar: "The whole team were in there for eight to 10 hours every day for 10 days, and we didn't find anything. And I think it was day five or six that we had a kind of eureka moment when all of a sudden Ed says, my pain, you know, just washed off of me." [02:07]
Ed's sudden relief after prolonged exploration underscored the potential of DBS, affirming that Dr. Srivalkar's efforts were far from futile.
Diagnosing Pain: Beyond Subjective Measures
A significant portion of the discussion centers on the difficulty of diagnosing pain objectively. Unlike measurable vital signs such as temperature or heart rate, pain lacks a tangible metric, historically referred to as the "fifth vital sign."
Dr. Prasad Srivalkar: "One of the holy grails of pain medicine has been coming up with a biomarker for measuring how intense or how severe somebody's pain is." [07:46]
Dr. Srivalkar elaborates on his lab's efforts to identify brain signals that correlate with pain intensity, aiming to develop a biomarker that could objectively quantify pain levels. This advancement could transform pain management, especially for individuals unable to communicate their pain effectively, such as those with dementia.
Treatment Modalities: From Medications to Neuromodulation
The conversation shifts to current pain treatment strategies, highlighting the limitations of existing modalities. Dr. Srivalkar categorizes pain into three main types:
- Myofascial or Muscular Pain: Resulting from muscle knots or conditions like arthritis.
- Inflammatory Pain: Often associated with arthritis and other inflammatory conditions.
- Neuropathic Pain: Characterized by electric or tingling sensations.
Dr. Prasad Srivalkar: "When pain becomes chronic, it starts to take on these other dimensions that include mood and motivation and involve attention and memory." [21:41]
Chronic pain, unlike acute pain, involves complex interactions between physical sensations and psychological factors, necessitating a multimodal treatment approach. Dr. Srivalkar emphasizes the importance of addressing cognitive aspects, such as depression and anxiety, which often accompany chronic pain.
The Opioid Crisis and Its Impact on Pain Research
Dr. Srivalkar discusses the historical dominance of opioids in pain management and the consequent lack of investment in alternative therapies.
Dr. Prasad Srivalkar: "There’s been a bit of a monopoly from the opiate manufacturers... the money wasn’t flowing elsewhere." [05:07]
The opioid epidemic has underscored the urgent need for non-addictive pain treatments, driving research into innovative solutions like DBS and other neuromodulation techniques.
Chronic Pain and Mental Health: An Interwoven Relationship
A crucial theme is the intricate link between chronic pain and mental health. Dr. Srivalkar points out that chronic pain often coexists with depression, anxiety, and a history of trauma, complicating treatment.
Dr. Prasad Srivalkar: "Having a traumatic experience in your childhood... really increases the chance of having chronic pain later in life." [16:49]
Understanding these connections is vital for developing comprehensive treatment plans that address both physical and psychological components of pain.
Future Directions: Biomarkers and Ethical Considerations
Looking ahead, Dr. Srivalkar is optimistic about the development of reliable pain biomarkers. His 2023 study marked a significant milestone by identifying distinct brain signatures for acute versus chronic pain, laying the groundwork for future research.
Dr. Prasad Srivalkar: "We have the clinical understanding and intuition. Chronic pain is not just a more enduring version of acute pain... we found that there's actually quite distinct brain signatures for acute pain and chronic pain." [20:33]
However, he also cautions against over-reliance on these technologies. While biomarkers could enhance pain assessment, they should complement rather than replace patient-reported experiences.
Dr. Prasad Srivalkar: "The ground truth is what the person tells me. These biomarkers should never be used to undermine or distrust patients." [25:52]
Conclusion: Bridging Technology and Empathy in Pain Management
Dr. Sanjay Gupta wraps up the episode by emphasizing the delicate balance between technological advancements and the human aspect of pain treatment. He highlights Dr. Srivalkar's commitment to using technology to support, not supplant, the patient-physician relationship.
Dr. Sanjay Gupta: "...the technology can help point physicians in the right direction and hopefully provide better care. It is the future that people have been hoping for when it comes to chronic pain for a long time." [27:27]
Dr. Gupta also mentions his upcoming book, reinforcing the episode's message that chronic pain management is an evolving field poised for significant breakthroughs.
Key Takeaways
- Subjectivity of Pain: Current pain assessment methods are largely subjective, underscoring the need for objective biomarkers.
- Deep Brain Stimulation: DBS offers promising avenues for treating chronic pain by targeting specific brain regions.
- Multimodal Treatment: Effective chronic pain management requires addressing both physical and psychological factors.
- Opioid Impact: The opioid crisis has highlighted the necessity for alternative, non-addictive pain therapies.
- Future Prospects: Ongoing research aims to develop reliable biomarkers, enhancing pain diagnosis and treatment personalization.
- Ethical Use of Technology: Technological advancements should support, not replace, patient-reported experiences, maintaining empathy in treatment.
This episode of Chasing Life provides an insightful exploration into the future of pain management, blending cutting-edge science with compassionate patient care. For those grappling with chronic pain or interested in the latest medical advancements, Dr. Sanjay Gupta and Dr. Prasad Srivalkar's dialogue offers hope and a vision for a more effective and empathetic approach to pain.