Narrator (2:19)

Scientists then simply listen to the billions of neurons in the brain and see what areas fire up when the patients have pain.

Dr. Prasad Shivalkar (2:28)

And we're targeting key areas.

Narrator (2:31)

I told you, it's audacious. About as cutting edge as it gets.

Dr. Prasad Shivalkar (2:35)

So telling someone you're going to drill holes in their skull, it should raise concern.

Interviewer/Host (2:41)

So they tell you all this and your first reaction is what?

Ed Mowry (2:45)

I hung the phone up.

Dr. Prasad Shivalkar (2:48)

Click.

Ed Mowry (2:49)

No way. Ain't happening.

Narrator (2:51)

After being a real daredevil in his early years, 54 year old Ed Mowry had collected a lifetime of injuries and a lifetime of pain.

Dr. Sanjay Gupta (3:00)

34 surgeries.

Medical Student/Resident (3:02)

Wow.

Ed Mowry (3:02)

11 knee surgeries. I had my right knee replaced. I've had C3 to T1, L4 to S1. All fused, all new discs.

Narrator (3:11)

Initially, Ed would heal and the pain would subside. But then, starting in 2009, after knee surgery, a relentless pain developed like he had never felt before.

Ed Mowry (3:22)

Unbelievable burning, just non stop. Think about the worst burn you've ever had in your life and multiply it by 10 or 20, and then it never, ever stops. Yeah, it's, you know, it feels like someone's cutting the bottom of your feet. Quite painful. I would say it's more than painful.

Narrator (3:39)

It took 10 years and lots of doctors for Ed to be diagnosed with complex regional pain syndrome, or crps. It usually occurs after an injury or an operation. And while it can occur anywhere in the body, it usually affects the hands or feet.

Interviewer/Host (3:55)

So in a sense, maybe it was.

Dr. Sanjay Gupta (3:57)

The surgeries, but it seemed to have.

Interviewer/Host (3:59)

Started you on the cycle of pain.

Ed Mowry (4:00)

Yeah.

Dr. Sanjay Gupta (4:01)

Now you might wonder, and so did I. If the surgery that kicked off Ed's chronic pain was in his knee, then why was the pain now so profound in his feet? Well, the best way to think about this may be like the phantom pain of an amputee. That's pain in a limb that no longer even exists. After all, Ed had no cuts or bruises, no visible injuries. This pain was being completely manufactured in his brain.

Ed Mowry (4:28)

Manufactured pain from the brain with no stimulus. It's unreal.

Dr. Sanjay Gupta (4:34)

So that's just your brain creating the pain?

Ed Mowry (4:37)

Yes. The Lyrica and the morphine will be first.

Narrator (4:39)

He did try a very long list of pain pills, and these are all.

Ed Mowry (4:44)

The ones that I was on.

Dr. Sanjay Gupta (4:45)

God.

Interviewer/Host (4:46)

So Hydrocodone, Norco, Celebrex, Vicodin, Percocet, Oxycodone, Dilaudid, Demerol, Tramadol, Temazepam, Gabapentin, Methacarbamol, Baclofen, Valium, Flexeril. I don't even know this one.

Dr. Sanjay Gupta (5:02)

Did you ever had zero pain, even when you're on these meds?

Narrator (5:05)

No. Eventually, he had enough and was willing to do anything, even brain surgery.

Ed Mowry (5:11)

I thought, you know, let them do whatever they gotta do just to get me out of pain.

Narrator (5:17)

In the fall of 2024, Ed had electrodes implanted deep into his brain.

Dr. Prasad Shivalkar (5:24)

You're seeing here Ed's brain. And all of these little colors represent probes.

Dr. Sanjay Gupta (5:29)

And there are as many neurons in your brain, if not more, than there.

Interviewer/Host (5:32)

Are stars in the sky.

Ed Mowry (5:33)

Yeah, exactly.

Interviewer/Host (5:35)

It's like throwing a telescope up at the sky and just seeing what you see or hearing what you hear?

Ed Mowry (5:40)

Yeah.

Interviewer/Host (5:42)

Quite a daunting task.

Dr. Prasad Shivalkar (5:43)

And we're actually recording activity from each one of those 140 contacts to try to identify where to stimulate. But identify what is the signal? The biomarker that tracks his pain.

Narrator (5:55)

And for the first time ever, they obtained a real time pain map. What you're looking at is Ed's brain in pain. And then they pass an electrical current into Ed's pain centers.

Dr. Prasad Shivalkar (6:09)

Dropped to zero.

Narrator (6:09)

And watch what happened.

Dr. Prasad Shivalkar (6:11)

Both dropped to zero to zero.

Ed Mowry (6:13)

Yeah.

Dr. Prasad Shivalkar (6:13)

You don't feel pain right now.

Narrator (6:14)

You don't feel nothing.

Ed Mowry (6:15)

I feel my. I feel my feet.

Dr. Eric Garland (6:17)

Yeah.

Ed Mowry (6:17)

Like I can, but yeah. Yeah, the pain's gone. Pain's done.

Dr. Prasad Shivalkar (6:23)

You're not kidding me. I believe. You're not kidding me.

Interviewer/Host (6:26)

It dropped.

Medical Student/Resident (6:27)

I mean.

Ed Mowry (6:27)

I mean, it's barely hooking at a 1 on both of them.

Dr. Prasad Shivalkar (6:30)

That's incredible.

Ed Mowry (6:31)

It was like a veil lifting. It was like a ton of bricks falling off your shoulders. It was all at once. All that. All at once. And it was euphoric.

Interviewer/Host (6:41)

But that was the first time in.

Dr. Sanjay Gupta (6:42)

A long time, Ed, that you had.

Interviewer/Host (6:44)

Not been in pain.

Ed Mowry (6:46)

Yeah, it's like the best drug I ever did, and I didn't do any drugs.

Patient (possibly the narrator's mother) (6:51)

Yes.

Dr. Prasad Shivalkar (6:52)

We were not expecting that at all. It surprised me how quickly he responded. But you hit a particular spot, and it changes their life.

Ed Mowry (6:59)

I'm able to tell you exactly the number of my pain.

Narrator (7:04)

I visited Ed in his hometown of Albuquerque, New Mexico, to see just how much it had changed his life. Walking, exercising, just enjoying time out with friends and also traveling the world with his music. Hey, buddy.

Dan Kruger (7:20)

Hey.

Ed Mowry (7:21)

What's happening, guys?

Narrator (7:21)

He continues to meet with Shivalkar's team to monitor his implants remotely. Checking in from New Mexico.

Dr. Prasad Shivalkar (7:27)

All right, there you go.

Patient (possibly the narrator's mother) (7:28)

Nice. Look at that.

Narrator (7:29)

We're in here. Since the brain is a dynamic organ, they are always tweaking the settings. He even felt it turn on during our interview.

Ed Mowry (7:37)

I can feel the pain go.

Medical Student/Resident (7:39)

Wow.

Ed Mowry (7:39)

Yeah.

Interviewer/Host (7:40)

Geez. You know, I gotta say, because I've been a neurosurgeon for, you know, long, long time. I haven't heard that level of description before.

Narrator (7:48)

Yeah, that's pretty wild.

Ed Mowry (7:49)

Yeah, it's.

Dr. Eric Garland (7:50)

It's.

Ed Mowry (7:51)

I think it's pretty much what makes me one of the first cyborgs in the United States. It's 100% changed my life.

Dr. Prasad Shivalkar (7:59)

I mean, Ed is a pioneer. You know, Ed is one to help himself, but really to help humanity to make this world better. And that's just. It's priceless to me.

Ed Mowry (8:12)

I feel like I owe him my life.

Narrator (8:14)

Invasive brain surgery for pain. Obviously, this won't be an answer for the masses, but look at what we have learned. Pain lies in the brain. It is measurable. It is predictable, preventable.

Dr. Prasad Shivalkar (8:28)

There's hope. A lot of scientists are tirelessly working around the world to try to make your life better in the next five to 10 years.

Interviewer/Host (8:36)

Okay, five to 10 years. We'll come back and check in.

Narrator (8:39)

That's the future. But coming up, what doctors are offering today to treat your pain.

Interviewer/Host (8:46)

So hopefully this will give you enough pain relief.

Narrator (8:49)

An alternative to opioids when we come back. But first, some pain points. How to find the best doctor for your pain. There are so many doctors who treat pain. Besides your primary care doctor, there are neurologists for brain and spine related pain, orthopedics for bones, and rheumatologists for joint pain. One thing to keep in mind, though, chronic pain hardly ever occurs in isolation, it always comes with baggage attached. Depression, anxiety, poor sleep. Sometimes the pain worsens those things, and sometimes those things worsen the pain. But here's the point. Addressing the baggage is as important as addressing the pain itself. You need both.

Dr. Sanjay Gupta (9:42)

If you've read anything about pain over the past 20 years, you've likely been angered by the opioid epidemic. During the worst years of the CRIs, doctors routinely used opioids for just about any kind of pain, from dislocated hips to toothaches. Opioids were promoted as wonder drugs. And the number of opioid prescriptions in the United States continued to rise until around 2011, as did death tolls and overdoses. Now, because opioids consume so much of the conversation, most people don't even realize there are plenty of other effective options to help relieve pain.

Narrator (10:24)

This is the ER at Maimonides, Brooklyn's largest hospital. It looks and sounds like a typical level one trauma center.

Dan Kruger (10:35)

Can we also repeat a cbc?

Narrator (10:38)

But as you'll soon learn, there's something very unique and groundbreaking happening here.

Dr. Luke Weber (10:44)

Sounds good.

Narrator (10:45)

Dr. Luke Weber and his team of residents are about to start the afternoon shift.

Dr. Luke Weber (10:50)

What we're actually going to see, very unpredictable. We got to be ready for anything.

Interviewer/Host (10:53)

Chest pain, car accidents, gunshot wounds, stabbings.

Dr. Luke Weber (10:58)

Anything that comes through, we're ready for.

Narrator (11:01)

He estimates that 70 to 80% of the people who will come here today will do so because of pain.

Interviewer/Host (11:09)

Is opioids still sort of the therapy of choice?

Dr. Luke Weber (11:12)

Opioids is one of our therapies. But we take a lot of pride here in offering a Wide variety of pain modalities.

Narrator (11:20)

It's called opioid optimization and it's pioneering work designed by this man.

Medical Student/Resident (11:26)

Did you fall at all?

Narrator (11:27)

No. Dr. Sergei Motov, an emergency medicine physician and research director at Maimonides.

Medical Student/Resident (11:34)

We decided to use non opioid analgesia as a primary analgesic of choice, obviously after patient's agreement. And resort to opioids only as a rescue.

Narrator (11:44)

That's right. Opioids as the last resort for pain instead of the first. It's standard operating procedure here now and they have found most of their patients are quite satisfied.

Interviewer/Host (11:57)

An option that you would use instead of an opioid. What would be an example?

Dr. Luke Weber (12:00)

We're starting to do more and more nerve blocks in the er. It's quick, easy, and it works for hours and hours.

Narrator (12:06)

This might sound familiar. Injecting local anesthetic at the site of an injury to block the nerves from feeling pain in that area. It's like an epidural during childbirth. But using these nerve blocks in the emergency room, that's cutting edge.

Interviewer/Host (12:21)

I'm just going to lower your bed a little bit.

Narrator (12:22)

Okay. Here they actually have a whole nerve block team at the ready. This is 76 year old Joseph. Today he's being treated for a broken hip. In most ERs around the country, you can bet he would have been given opioids.

Dr. Prasad Shivalkar (12:37)

I do not take drugs.

Narrator (12:39)

I took drugs in the 60s. No more.

Interviewer/Host (12:42)

Gonna feel a slight poke.

Narrator (12:44)

The procedure took less than 10 minutes.

Interviewer/Host (12:47)

So hopefully this will give you enough pain relief so we don't have to use any other type of pain medicine like, like opiates.

Narrator (12:55)

And Joseph felt pain relief almost instantly. Good, no pain.

Interviewer/Host (13:01)

That's kind of incredible because I mean, I think the knee jerk response you get, somebody comes in with a fracture, probably getting opioids, at least that's what I heard.

Dr. Luke Weber (13:11)

You're absolutely right. That's a common knee jerk reaction in the er, unfortunately. But places like this, we're really trying to kind of change that paradigm.

Narrator (13:22)

Another step toward changing the paradigm. Educating doctors.

Medical Student/Resident (13:26)

Any questions?

Narrator (13:27)

Even before they become doctors, how many.

Medical Student/Resident (13:30)

Of you believe that pain is properly treated in the emergency department?

Narrator (13:35)

For the past five years, MOTAV has given pain talks once a month to medical students. And I was surprised to learn that for some of these medical students in attendance, they had spent just a few hours on pain management during all four years of med school.

Interviewer/Host (13:49)

Was there something that you took away from today's lecture that would change how you think about opioids, how it's going.

Narrator (13:55)

To affect that patient when they walk away? And how much responsibility am I willing.

Patient (possibly the narrator's mother) (13:59)

To take on if I do choose.

Narrator (14:01)

To prescribe an opiate?

Medical Student/Resident (14:02)

So just put in perspective in the numbers.

Narrator (14:04)

These students are being taught non opioid options early on.

Medical Student/Resident (14:09)

So ibuprofen, naprosyn. Would you talk about acetaminophen?

Dr. Sanjay Gupta (14:14)

Tylenol?

Medical Student/Resident (14:14)

Tylenol, exactly.

Narrator (14:17)

When used intravenously, Tylenol can help supplement other medications to help manage moderate to severe pain. And a new non opioid pain medication, Suzetragine, marketed as Journavax, was just approved by the FDA earlier this year.

Medical Student/Resident (14:35)

Incredible breakthrough, you know, sort of long overdue. It's the first new drug that has viable analgesic efficacy over the past, what, 20 to 25 years?

Dr. Sanjay Gupta (14:46)

It is shocking, actually. It's the first new pain medication approved in 25 years. I mean, Celebrex was the last one, and that was 1998. And just to give you some context, the FDA approves around 40 to 50 new drugs a year. And yet, as common as pain is, there were no new drugs for a long time. It's amazing to me, as you saw new medications developed for heart disease and diabetes and cancer and immunotherapies, the fastest growing condition in the United States, chronic pain, had nothing new to offer these patients in terms of medications.

Dr. Prasad Shivalkar (15:22)

For so long, there's been a bit of a monopoly from the opioid manufacturers on marketing in pain. And so the money wasn't flowing elsewhere.

Interviewer/Host (15:31)

Opioids sort of sucked all the oxygen up in the room.

Dr. Prasad Shivalkar (15:33)

That's a good way to put it.

Dan Kruger (15:34)

Yeah.

Medical Student/Resident (15:35)

We've been so focused on this battle against opioids. If we've been sort of repurposing rather than exploring new drugs at much greater extent.

Narrator (15:45)

One drug they're successfully repurposing, ketamine. It works by temporarily blocking a special receptor called nmda, which is associated with pain. It really seemed to work for 55 year old Dan Kruger and international motorbike racing champion. Dan has had a lot of injuries.

Dan Kruger (16:09)

I've broken toes a number of times, both my feet and both my ankles. I broke five ribs the same time I broke the collarbone two years ago.

Narrator (16:19)

With all those injuries came pain, and with pain came opioids.

Dan Kruger (16:25)

I was a functioning addict. I was planning my days around it. My priorities started with, how many pills will I need today?

Narrator (16:36)

After an overdose nearly killed him, Dan knew he had to quit. Not racing, but the drugs.

Dan Kruger (16:43)

The challenge was I still race motorcycles, so I still get injured.

Narrator (16:49)

After a particularly gruesome crash three Years ago in Atlanta, Dan woke up from emergency surgery with one request.

Dan Kruger (16:57)

The very first thing I said to the doctor in there was no opioids. So they just started giving me ketamine shots to help with my pain. It was amazing because the pain would go away immediately, like instantly.

Dr. Sanjay Gupta (17:10)

Take a minute and think about the last time you were in pain. Maybe it was a stubbed toe or a headache or maybe something more serious. It can really take over your life and your thoughts. You start to anticipate it and think about it and worry about how bad it's going to get. You wonder if the pain will ever stop. Can't really think about anything else. And it made me wonder if there was a way to break that thought cycle and almost think or will the pain away? Turns out there is.

Narrator (17:42)

July 2025. Race day for motorcycle champion Dan Kruger.

Dr. Sanjay Gupta (17:53)

155 laps, 170 miles an hour, 101 degrees.

Narrator (18:03)

Halfway through the four hour race, Dan is in pain.

Dan Kruger (18:07)

It's rough, I'm not gonna lie. It's really challenging out there.

Narrator (18:12)

But the speed, the power, the thrill, it all drives him. It's addictive. Almost as addictive as all the opioids that got him through the pain in the first place.

Dan Kruger (18:25)

A lot of oxy's.

Interviewer/Host (18:26)

What is it like for you to look at all these pill bottles?

Dan Kruger (18:29)

I really just kind of knew that I had a task. I had to get off them and move forward.

Dr. Eric Garland (18:37)

You're strengthening mindfulness.

Narrator (18:40)

Something. Something he was able to do with.

Dr. Sanjay Gupta (18:42)

A new treatment that he does before every race.

Narrator (18:47)

Meditation. A new take on a centuries old practice. It is now part of his daily life. We even decided to try it during a break from our interview at his lakefront home in Georgia.

Dan Kruger (19:04)

As soon as I'm sitting down meditating, I know I'm in for a good 15 minutes of pain free, pain free.

Dr. Eric Garland (19:13)

Turn the focus of the attention back to the breath.

Narrator (19:18)

Now that quiet, peaceful voice guiding his meditation is Dr. Eric Garland, a professor of psychiatry at the University of California, San Diego.

Dr. Eric Garland (19:27)

I've turned to mindfulness as a potential treatment for pain because mindfulness is all about bringing attention into the present moment.

Narrator (19:37)

For years, Garland worked with primary care physicians and their patients who reported pain. And he used powerful mindfulness techniques like meditation and behavioral therapy to try and treat their pain. Three years ago, when Dan was looking for treatment options, he stumbled onto Garland's work.

Dr. Eric Garland (19:57)

Turning your attention inward.

Dan Kruger (19:59)

The very first time we did the guided meditation. All my lower back pain, all my si pain, all my aches and Pains, my headaches, gone. The entire 20 minutes we'd meditate, gone. Like 100% gone. I knew that I wouldn't take another.

Dr. Eric Garland (20:16)

Opioid look at the screen and focus on the image.

Narrator (20:20)

Six months of working with Garland and Dan was weaned off the opioids completely.

Dr. Eric Garland (20:26)

When they learn the technique, people can get on average about that 25% or 30% reduction in pain immediately after 15 minutes of mindfulness. Now that's just an average, right? So some patients can experience even more pain relief from mindfulness.

Narrator (20:44)

The NIH and other government agencies have funded Garland's research and the results have been impressive.

Dr. Eric Garland (20:53)

We've studied the mindfulness meditation practices and find that on average, they reduce pain by about 25 or 30% in the moment. And that's about as much pain relief as you would achieve from 5 milligrams of oxycontin.

Dr. Sanjay Gupta (21:06)

I want you to really take that in meditation. Mindfulness potentially as good, if not better for some than opioids. And without the risks and the high abuse potential those drugs have, it's about as low tech as you can get. And you can really do it anywhere. The success stats are hard to believe, so I went to Dr. Garland's lab to put it to the test.

Dr. Eric Garland (21:30)

This is a device for delivering heat stimulation to your arm. And so it's going to deliver five 10 second long pulses at 48 degrees Celsius, which is about 119 degrees.

Interviewer/Host (21:44)

Okay.

Dr. Eric Garland (21:45)

And so you're gonna experience it, and then I'm gonna ask you to rate your pain. Okay, here we go.

Narrator (21:51)

So that first round, five powerful bursts of extreme heat on my arm. I gotta say, it was pretty intense and pretty unpleasant.

Dr. Eric Garland (22:00)

So when you're ready, you can allow your eyes to close.

Narrator (22:03)

And then Garland just talked me through some basic meditation techniques back to the.

Dr. Eric Garland (22:09)

Sensation of the breath. Ready to try the heat again?

Interviewer/Host (22:13)

Yeah, let's do it.

Narrator (22:15)

And then I was ready for another round of 119 degree pulses on my arm. This time I was just meditating the.

Dr. Eric Garland (22:22)

Whole time and just letting that sensation go bother you.

Narrator (22:27)

And then the results. He had measured my intensity and unpleasantness scores.

Dr. Eric Garland (22:32)

He went from a 7.4 in pain intensity to a 3.7 in pain intensity. And you went from a 4.7 in pain unpleasantness to a 1.1 in pain unpleasantness.

Interviewer/Host (22:46)

That's incredible.

Dr. Eric Garland (22:46)

Those are huge effects.

Narrator (22:48)

No drugs, just training the brain.

Dr. Eric Garland (22:52)

When you generate these peaceful and positive feelings during the practice of mindfulness, that can be analgesic in and of itself. Not only does Mindfulness do decrease the intensity of the pain, but it's really powerful in decreasing its unpleasantness. It just makes pain less bothersome. So the sensation is still there, but you're just not as upset about it, Right?

Interviewer/Host (23:13)

I think that's exactly how I would describe it.

Narrator (23:15)

Even Dr. Srivalkar, a high tech brain expert, supported this low tech approach to pain.

Dr. Prasad Shivalkar (23:22)

I really believe one of the most powerful things we can do as humans is learn to train our brain.

Narrator (23:31)

Train your brain to fight pain every day.

Patient (possibly the narrator's mother) (23:35)

Try to do a little bit more, little bit more.

Narrator (23:37)

It sounded familiar to me.

Patient (possibly the narrator's mother) (23:39)

If you train your brain not to think about these things, if you can control, I think it will work better.

Narrator (23:50)

Moms are always right. Turns out my mom had also used mindfulness to help her her pain.

Patient (possibly the narrator's mother) (23:56)

I just sit quietly and focus on something nicer and say, I want this thing to go away. And does go away.

Narrator (24:09)

No one is saying that meditation and mindfulness alone can eliminate pain for most people. Because if you've learned anything, it is that pain is complicated and that means there is no one size fits all. You gotta put all of it together.

Dr. Prasad Shivalkar (24:24)

When someone has developed chronic pain, treating it with a single drug or an injection or some monotherapy probably isn't gonna work. We have to address people's thinking patterns, make sure that they're eating well, exercising as much as possible. It really requires kind of a multimodal approach.

Interviewer/Host (24:45)

How are you feeling right now?

Ed Mowry (24:46)

Just good. I have no pain at all.

Narrator (24:49)

That holistic approach is what brought the most success to the people we've met.

Ed Mowry (24:53)

During this show, I started dieting. Right. I started working on music and doing all the things that I love doing because I hadn't been able to do it for so long. It's wild. It's hard to describe.

Narrator (25:06)

I realized that for 20 years, I've not been who I really am. I felt like I got my life back.

Interviewer/Host (25:13)

Try and keep up, all right? I'll follow you.

Narrator (25:19)

In one way or another, they all got their lives back, taking control of and then conquering their pain.

Interviewer/Host (25:29)

Are you surprised that you feel as.

Dr. Sanjay Gupta (25:31)

Well as you do?

Patient (possibly the narrator's mother) (25:32)

Yes.

Interviewer/Host (25:33)

You didn't think you were going to get to this point?

Patient (possibly the narrator's mother) (25:36)

I thought it would be challenging, but I'm very grateful to God that I can do everything.

Interviewer/Host (25:46)

You seem happy.

Patient (possibly the narrator's mother) (25:47)

I always like to be happy. Things happen and one has to learn to live with it.

Interviewer/Host (25:54)

What do you think things are going to look like a year from now for you?

Patient (possibly the narrator's mother) (25:57)

Probably same.

Interviewer/Host (25:58)

Do you think that you'll be walking even faster?

Patient (possibly the narrator's mother) (26:01)

Yes.

Interviewer/Host (26:02)

Okay.

Narrator (26:04)

And you know what? I believe her. We'll be back next Tuesday with paging Dr. Gupta.

Dr. Sanjay Gupta (26:10)

Thank you so much for listening. Hey there. It's Sanjay. And I wanted to take a moment to simply say thank you.

Interviewer/Host (26:23)

Thank you for being here.

Dr. Sanjay Gupta (26:24)

You know, I've been thinking about this past year a lot on chasing life. Over 83 episodes, more than 32 hours of science and storytelling. But I gotta tell you, what really stuck with me was you, the listener and the questions. During paging Dr. Gupta, for example, you asked so many questions, you left so many comments. You gave us your thoughts. And health is intimate, so there's many, many things that you're sharing that are deeply personal. Sometimes the questions didn't always have easy answers. So we dug and dug, and those questions pushed us to keep learning and growing ourselves so we can understand ourselves, all humans, more deeply. So I just want to say thank you. You've helped make this show what it is. Stay curious. And here's to another year of Chasing Life.