Dr. Gurpreet Singh Padda, MD Publishes The Pained Brain, Arguing Chronic Pain Is a Metabolic Disease the Scan Cannot See

A 479-page, 22-chapter volume coauthored with Dr. KrisJay Fucanan, MD, documents 2,291 references published at thepainedbrain.com.

St. Louis, MO, United States — September 21, 2026

Dr. Gurpreet Singh Padda, MD, MBA, MHP, an interventional pain physician, anesthesiologist, and addiction medicine specialist who has led the Center for Interventional Pain Management in St. Louis since 2001, has published The Pained Brain: Chronic Pain: Felt in the Body, Made in the Brain. The book is the second volume in his series The Brain, and it makes an argument that runs counter to how most American medicine is organized: chronic pain is not a local structural defect waiting for a local repair. It is a centralized nervous-system pathology fueled by systemic metabolic inflammation, and a joint treated in isolation from that terrain will keep hurting.

The price of the current model

Dr. Padda opens the book not with anatomy but with arithmetic. Chronic pain costs the United States $722.8 billion a year in medical spending and lost work, and a person living with it spends $8,068 a year more on medical care than a person without it (Guy et al., 2025). The human column is worse. In a Danish population study, people with chronic pain died from lung disease at nearly nine times the rate of those without it, and from suicide at seven times (Vaegter et al., 2019). In a United States review of suicide records where a note survived and its contents were recorded, 67.4 percent of those notes named the pain as part of the reason (Petrosky et al., 2018).

“We keep pricing chronic pain as a productivity problem. It is a mortality problem. People are not just unable to work. They are dying earlier, and a meaningful number of them are choosing to. If a cancer therapy produced that record, we would have pulled it. In pain, we call it standard care and schedule the follow-up.”

Pain is a signal, not a diagnosis

The book’s second chapter states the thesis in four words, and the rest of the volume defends it. Pain is a biological alarm reporting that something has drifted out of balance. Silencing the alarm without finding the fire, Dr. Padda writes, guarantees the house burns down on a delay.

Chapter 3 takes that argument to imaging, which is where most patients form their beliefs about their own bodies. The Lancet’s 2018 low back pain series concluded that “for nearly all people with low back pain, it is not possible to identify a specific nociceptive cause” (Hartvigsen et al., 2018). Degenerative findings turn up across pain-free populations at rates that make any single scan a poor witness. The book also documents what the language of a report does to a patient: told they had “arthritis,” “degeneration,” or “a disc bulge,” people rated their need for further imaging at 5.7 to 6.0 out of 10; told they had “an episode of back pain,” 4.2 (O’Keeffe et al., 2022). The word chosen in the radiology suite changes what the patient goes on to consume.

The hormone nobody measured

The book’s metabolic spine arrives in Chapter 4. Among nondiabetic United States adults in NHANES, the share with measurable insulin resistance rose from 24.8 percent to 38.4 percent between 1999 and 2018 (Wu, Ke, & Nianogo, 2025), a population shift that occurred almost entirely outside the attention of pain medicine. In a separate cohort, each unit rise in a bedside index of insulin resistance raised the odds of new severe chronic pain 1.51-fold (Zhao et al., 2026). From there the book follows the chemistry forward: the omega-6 load of the modern diet supplying the raw material for inflammatory prostaglandins, advanced glycation end products stiffening collagen and entrapping nerves, a disrupted circadian clock taking the body’s own analgesia offline, and finally central sensitization, the point at which the nervous system no longer requires an injury to produce pain.

Later chapters turn to what can be done and what it costs: procedural precision, percutaneous hydro resection, regenerative options weighed against repeat corticosteroid injection, pain in the elderly, the regulatory environment, and the incentive structures that reward volume over resolution.

Written to be checked

Every figure in The Pained Brain is given as published, with its population named and its paper attached. Each chapter closes with a printed code that opens a free technical supplement, written at a level a reader can put in front of their own physician, and those supplements carry 2,291 documented references. Where the evidence is thin or points the wrong way, the book says so instead of selling past it. The supplements are published at thepainedbrain.com, one chapter at a time. Readers who would rather be walked through the argument can watch it instead: all 22 chapters exist as a video series on the Padda Institute channel.

“I am asking people to distrust a scan they paid for and a story they have been told for years. The only way to earn that is to show every number and name every population, including the studies that cut against me. You are probably going to dislike me somewhere in the middle of this book. I would rather be argued with than believed.”

Availability

The Pained Brain: Chronic Pain: Felt in the Body, Made in the Brain by Dr. Gurpreet Singh Padda, MD, MBA, MHP, and Dr. KrisJay Fucanan, MD, is available now on Amazon in Kindle and paperback editions. Paperback ISBN 978-0-9832058-1-4. Published by Nectar Media Group. 479 pages, 22 chapters. It is the second volume in The Brain, following The Starved Brain and preceding The Angry Gut, The Dopamine Brain, and the forthcoming The Humbled Brain.