By Alicia Jerome MS, RD, LD
Chronic pain is no longer a niche clinical issue. It is a defining public health challenge. Nearly one in four adults reports living with chronic pain, and new cases of chronic pain now outpace diagnoses of diabetes, hypertension, and depression1. For nutrition and health professionals working on the front lines of prevention, lifestyle intervention, and behavior change, pain is not a specialty topic. It is foundational.
Reframing Pain: From Tissue Damage to Brain-Based Experience
Dr. Sanjay Gupta offers a new book to the conversation of pain. One of the most valuable contributions It Doesn’t Have to Hurt offers is its clarification of pain types. While nociceptive pain, pain arising from tissue injury, remains the most common form, Gupta highlights the growing recognition of neuroplastic pain, where pain persists despite tissue healing1. Conditions such as fibromyalgia, irritable bowel syndrome, and many cases of chronic low back pain fall into this category.
This distinction matters deeply for health professionals. Treating neuroplastic pain with interventions designed for structural injury often leads to frustration, overmedicalization, and unnecessary procedures. Pain is not merely about nociception; it is also shaped by perception, attention, memory, and neuroception which is the brain’s unconscious assessment of threat1. This reframing empowers practitioners to guide clients toward strategies that calm the nervous system rather than escalate fear and sensitization.
Assessment Matters: Listening is a Clinical Skill
It Doesn’t Have to Hurt underscores the importance of structured pain assessment tools, such as the WILDA (words, intensity, location, duration, and aggravating and alleviating factors) questionnaire, while acknowledging that pain intensity remains the most subjective and clinically challenging parameter1. This is a critical reminder for nutrition professionals who may feel pain assessment falls outside their scope. Understanding how pain is described, what aggravates or alleviates it, and how it impacts identity and daily functioning enhances rapport and improves outcomes across all lifestyle interventions.
Nutrition, Supplements, and the Reality of Evidence
Unlike many popular pain books, It Doesn’t Have to Hurt does not oversell supplements or dietary cures. Instead, Gupta provides balanced, evidence-informed guidance that respects both potential benefits and risks.
The book reviews evidence related to specific nutrients and dietary patterns in the context of pain management. It discusses minerals and vitamins such as magnesium for musculoskeletal pain, riboflavin for migraine prevention, and coenzyme Q10 in relation to recovery following physical exertion, while also noting potential risks, including an increased risk of kidney stones associated with turmeric use in certain individuals1. These examples reflect the importance of weighing potential benefits against safety considerations when making nutrition-related recommendations.
The Mediterranean dietary pattern is presented as a dietary framework associated with reduced inflammation and improved pain-related outcomes, with an emphasis on whole foods, phytonutrient-rich fruits and vegetables, healthy fats, and overall dietary quality rather than prescriptive or restrictive rules.
Movement as Medicine—Without Fear
A recurring theme throughout the book is that movement is essential, not optional, especially, for people in pain. Evidence is presented showing that most back pain improves with nonsurgical care within weeks and that physical inactivity carries its own mortality risk, helping to counter fear-based avoidance behaviors in chronic pain1. From yoga’s role in hard-to-treat low back pain to the benefits of breaking up sedentary time with brief bouts of light activity, the book provides clear, motivating data that health professionals can use to reframe exercise as a tool for healing rather than harm.
The Mind, the Brain, and the Path to Resilience
Perhaps the most compelling sections for integrative practitioners are those exploring the relationship between pain, mood, identity, and resilience. People with chronic pain are five times more likely to experience anxiety and depression, yet Gupta avoids pathologizing this connection1. Instead, he highlights therapies such as mindfulness-oriented recovery enhancement (MORE), pain reprocessing therapy, and savoring practices that retrain attention, reduce opioid misuse, and restore quality of life.
Importantly, resilience is described not as toughing it out, but as maintaining well-being even in the presence of ongoing stressors, which closely mirrors how resilience is approached in contemporary health coaching and behavior-change work.
Why This Book Belongs in Nutritional Education
The book’s breadth of topics, from pain physiology and pharmacology to nutrition, movement, mindfulness, and social connection, makes it particularly well suited for interdisciplinary education. It equips professionals not just to understand pain, but to communicate about it more effectively, compassionately, and confidently.
The book’s real strength is how clearly it connects modern pain science to everyday practice across fields such as nutrition, exercise physiology, behavioral health, and integrative care.
If this discussion resonated with you, you can take the next step by enrolling in It Doesn’t Have to Hurt, an engaging course that offers 19 CPE hours.
References:
1. Gupta, Sanjay. It Doesn’t Have to Hurt: Your Smart Guide to a Pain-Free Life. Simon & Schuster, 2025.