Fresh Air: "How Does Pain Work? Dr. Sanjay Gupta Explains"

Date: September 4, 2025
Host: Terry Gross
Guest: Dr. Sanjay Gupta, neurosurgeon and CNN chief medical correspondent

Overview

In this engaging episode of Fresh Air, host Terry Gross sits down with Dr. Sanjay Gupta to unpack the latest science behind pain—how we experience it, why our brains can sometimes get pain “wrong,” and what new techniques and treatments are emerging. Drawing on his new book, It Doesn’t Have to Hurt, Dr. Gupta shares both personal anecdotes and the newest medical findings, offering hope and insight for those who struggle with chronic and acute pain.

Key Discussion Points & Insights

Dr. Gupta’s Personal Story: Childhood Impalement and Early Lessons on Pain

• At 12, Dr. Gupta was impaled on a wrought iron fence. Surprisingly, he felt less pain than expected, leading to his fascination with the science of pain ([01:44]).
• Not all body parts have the same density of pain receptors (nociceptors); the back, for example, is less sensitive than hands or feet ([04:10]).

Quote:

“When I reflected on it … after a while, not only did it not hurt as much, I actually started to feel, strangely, a bit of euphoria.”
— Dr. Sanjay Gupta ([15:57])

The Brain’s Central Role: Interpreting Pain

• Pain isn’t experienced at the site of injury alone; it’s constructed by the brain ([05:37]).
• The brain can misinterpret pain signals—leading to phenomena like phantom limb pain or “referred” pain, where, for example, a heart attack presents as jaw pain ([07:02]).

Quote:

"When it comes to actually determining if something hurts and how much, that is the brain. The brain determines whether or not you have pain.”
— Dr. Sanjay Gupta ([06:19])

Chronic Pain and “Pain Loops”

• Chronic pain often outlasts physical injury due to persistent brain “loops,” sometimes tied to trauma, depression, anxiety, or even minor daily stressors ([08:44]).
• Chronic pain never occurs in isolation and is compounded by emotional and psychological “baggage” ([08:44]).

Can We Rewire How the Brain Interprets Pain?

• Dr. Gupta asserts the brain can be “trained” to turn down the volume on pain.
• Mindfulness and meditation can reduce perceived pain to zero for short periods—comparable to the relief from 5mg of oxycodone ([09:55], [11:57]).
• He shares a personal experience meditating with the Dalai Lama, noting even lifelong meditators admit to difficulty focusing ([12:45]).

Quote:

“The idea that you could take someone’s pain score from really terrible pain to a 0 out of 10 … for the 30 minutes that they are meditating, I think is real proof of concept.”
— Dr. Sanjay Gupta ([09:55])

The Power of Pleasure, Savoring, and Endorphins

• Actively savoring pleasure (e.g., enjoying food, gratitude) can biologically activate the body’s endorphins—internal “morphine,” raising pain tolerance and enhancing mood ([13:47]).
• The placebo effect may, in part, come from harnessing this endogenous opioid system ([14:30]).

Quote:

“We can activate this system in all sorts of different ways … not just practice gratitude, but to actively practice gratitude.”
— Dr. Sanjay Gupta ([13:47])

Medications: Opioids vs. Endogenous Opioids, Anti-inflammatories, and New Options

• Prescribed opioids mimic endorphins, but are less precise and can lead to over-remembering pain; our own “in-house” opioids turn off more cleanly ([17:48]).
• New pain medication, suzetragine, targets sodium channels in the brain, inspired by a Pakistani family unable to feel pain—offers sensation without numbness ([30:16]).

Quote:

“The last [pain] drug was approved in 1998 ... for pain, which is a condition that affects 20% of the population ... it’s pretty remarkable we hadn’t had a new option.”
— Dr. Sanjay Gupta ([30:16])

Inflammation and NSAIDs

• Inflammation is vital for healing; suppressing it immediately with anti-inflammatory drugs may worsen outcomes and increase risk of chronic pain ([23:07]).
• NSAIDs (like Advil) are not helpful for nerve pain, which needs different approaches ([25:34], [25:58]).

Cannabis for Pain

• Research is mixed; for one-third of chronic pain patients, cannabis is as effective as standard treatments, but it fails for two-thirds ([33:02]).

Quote:

“For about a third of the people it could be pretty effective … for about 2/3 of people, it really did not seem to be that effective.”
— Dr. Sanjay Gupta ([33:43])

Deep Brain Stimulation and AI

• A cutting-edge treatment places stimulators in the brain to “interrupt” pain in highly refractory cases. Machine learning is key to mapping pain signatures in the brain ([35:45], [38:31]).
• Discussion of a patient with chronic regional pain syndrome whose lifelong pain vanished when stimulation was activated ([38:38]).

Quote:

"The veil of pain just went away ... I've had this veil over my face and over my brain for decades and it just got lifted."
— Dr. Sanjay Gupta (relating a patient story, [39:36])

Notable Quotes & Memorable Moments

• On meditation’s power:
  “What [meditation] showed was basically similar to 5 milligrams of oxycodone. That’s what meditation can do for you.”
  — Dr. Sanjay Gupta ([11:57])

• On placebo and expectation:
  “Expectations and experience are inextricably linked, especially when it comes to pain.”
  — Dr. Sanjay Gupta, quoting researcher Julie Holland ([34:27])

• On the future:
  “Pain is very much in the brain, and we can objectify it in ways that we did not fully appreciate before.”
  — Dr. Sanjay Gupta ([38:58])

Timestamps for Key Segments

• Personal story of being impaled: [01:44]–[05:16]
• Pain as brain construct & misinterpretation: [05:37]–[07:13]
• Chronic pain and psychology: [08:44]
• Brain training/meditation: [09:55]–[12:45]
• Endorphins/savoring/pleasure: [13:47]–[15:57]
• Opioid system comparison and memory: [17:48]–[19:39]
• Inflammation and treatment myths: [23:07]–[25:27]
• New pain medication (suzetragine): [30:16]
• Cannabis and pain: [33:02]–[34:27]
• Deep brain stimulation and AI: [35:45]–[39:36]

Tone and Style

Richly anecdotal, evidence-based, and approachable—Dr. Gupta and Terry Gross maintain a conversational, relatable, and often empathetic tone, demystifying the science while offering hope and practical advice for pain sufferers.

This summary covers all major topics, using speaker-attributed quotes and clear time stamps, and should provide a comprehensive, engaging overview for new listeners or those looking for the episode’s key insights.