Americans have developed a unique “disdain for pain,” leading to the excessive use of opioids and other unproductive treatments, neurosurgeon Sanjay Gupta said Saturday at The Texas Tribune Festival’s closing keynote, during which he urged people to focus instead on the key driver of chronic pain: the brain.
That was among the core findings of Gupta’s research presented in his recent book, “It Doesn’t Have to Hurt: Your Smart Guide to a Pain-Free Life,” which promotes a mix of conventional approaches — like foam rolling and stretching — and unconventional fixes, such as psychedelics and other new-age pain products. Those can provide more enduring pain relief by tapping into the brain’s built-in endogenous opioid system, Gupta argues.
“For decades, the body was being treated as totally separate from the brain and I think that has been the biggest misconception,” he said. “We have learned that someone might have pain associated with isolation or loneliness, and it’s remarkable how similar that might look to physical pain.”
The brain, Gupta continued, “doesn’t really distinguish the difference in pain. It's not to say that it's all in your head, but the brain is making these determinations.” It does so by treating chronic pain “like a memory that keeps getting played over and over again,” he said, akin to post-traumatic stress disorder.
This revelation is still being studied, and while its future implications are still coming into focus, Gupta said it might eventually lead to more pain management that doesn’t rely on opioids.
Gupta has had plenty of experience witnessing how drugs can have both positive and negative effects on users. He said that in the early 1990s, the message became that it was no longer acceptable to live in pain, and opioids developed as the go-to solution.
“It was very effective, to be fair, in terms of treating pain — in the short term,” Gupta said.
Opioid medications are highly addictive and have produced deadly consequences for Texans and others across the country over the past decade.
The state’s drug overdose deaths spiked by more than 75% from 2017 to 2021, prompting state leaders to create a campaign dedicated to stopping the No. 1 killer, a synthetic opioid known as fentanyl. Deaths involving fentanyl have made up an increasing share of overdose fatalities, climbing from 3.7% of Texas’ 2,111 drug-related deaths in 2014 to 44% of 4,931 drug-related deaths in 2022, according to a report from the Texas Department of State Health Services.
Texas has seen a more recent decline in overdose deaths, with such fatalities decreasing by 18% from the 12 months leading up to April 2024 compared to the same months before April this year, according to provisional data from the federal Centers for Disease Control and Prevention.
For many years, Gupta said, the rise of opioids also suffocated the desire to search for new solutions for pain management. He noted that, while the U.S. Food and Drug Administration approves around 40 to 50 new drugs annually, this year saw the approval of the country’s first new pain medication since 1998.
“Think about it — chronic pain is one of the fastest growing conditions in the country, and yet, not a single new therapeutic in 27 years for that,” Gupta said.
Gupta also spoke about the state of public health in Texas and across the country, citing pessimism and mistrust of the nation’s health care system as one of his primary concerns. Those sentiments are tied to the high cost of care, he argued.
“If you look at the type of health care system that we have and how fragmented it is — how many people still don’t have access to healthcare, insurance or can access healthcare? — the inequity there is remarkable,” Gupta said. “So I think that is a source of great despair.”
In Texas, Affordable Care Act premiums are set to rise by an average of 35 next year if Congress does not renew expiring health care tax credits. The subsidies were at the center of the record-long shutdown of the federal government, which ended this week after lawmakers approved a funding deal that did not address the tax credits.
Texas is expected to be disproportionately affected by the expiration of the subsidies because it has more ACA enrollees — nearly 4 million — than every state but Florida. As one of 10 states that never expanded Medicaid to people earning over 100% of the federal poverty limit, Texas has significantly relied on the ACA to increase coverage for lower-income residents. Nearly two-thirds of Texans who get coverage through the ACA earn under 150% of the federal poverty limit — $23,475 for an individual or $48,225 for a family of four.
Gupta contended that dissatisfaction with the health care system is the main driver of vaccine skepticism being seen in Texas and across the nation.
School immunization rates have declined in recent years as more parents have sought to exempt their kids from required vaccines. Requests for a vaccine exemption form from the Texas Department of State Health Services have doubled since 2018, from 45,900 to more than 93,000 in 2024.
Gupta said he has spent the past few years battling misinformation over the safety of vaccinations and the Trump administration’s rollback of health mandates.
“I am not sitting it out,” he said. “I think a lot of people are sitting it out. I think now is the time to redouble efforts and put good truthful content out there that people can rely on.”
The challenge with battling misinformation, Gupta said, is that it often contains a kernel of truth. For example, he said, it is important to live a healthy lifestyle, as advocated by Health Secretary Robert F. Kennedy Jr. and some in the conservative Make America Healthy Again movement. But a healthy lifestyle alone cannot replace the need for vaccines and other proven public health measures.
“We do eat too much processed foods. We do spend too much on healthcare,” Gupta said. “But at what point do you say, hey, these things work, they provide benefit that are greater than risks and harms, and they’re good for society. I feel like we are going backwards in regards to this.”
This article first appeared on The Texas Tribune.