By Sreedhar Potarazu and Carin-Isabel Knoop
When Dr. Sanjay Gupta released his new book, “It Doesn’t Have to Hurt: Your Smart Guide to a Pain-Free Life,” he challenged us to think differently about pain. Some pain is inevitable, he notes, but much of what we experience can be managed by reshaping how the brain interprets it. Gupta’s core message is awareness: understanding what is within our control and what is not.
If pain is both perception and biology, how should we measure, anticipate, and respond to it in a world where suffering often goes unseen? Here we look at pain in the professional context where gains and losses are always part of the bargain after all. Pain is transactional — the loss of something in the hope of an eventual gain. Pain is a pendulum that swings between the anxiety of gain and fear of loss. Every pain carries a cost — sometimes it buys resilience, sometimes it buys nothing but depletion and exhaustion.
When we are in pain there is a loss, and we try to endure to build resilience which is a gain. But it’s a benefit at the expense of health, sanity, family and much more. For entrepreneurs, athletes and politicians and many others pain is a currency. In each of these situations we make the decision to “pay” with pain with the hopes of gaining wealth, performance, fame or better health. But there is a cost whether it is conscious or not. There are profits and losses, assets and liabilities. Sometimes we are profitable and other times bankrupt. The pain is deliberate.
The myth of “no pain, no gain”
But we often repeat the phrase “no pain, no gain” as though pain were simply the price of progress.
The saying dates to Benjamin Franklin, who in his 1734 “Poor Richard’s Almanack” wrote, “There are no gains without pains.” Two centuries later, it resurfaced in the fitness world, urging athletes to push past discomfort. By the 1980s, companies like Nike turned it into a cultural slogan and a marketing tool. What began as a reminder of hard work became a global brand of ambition. But pain framed as a necessary debit in pursuit of glory, wealth, achievement, or recognition sometimes obscures what gets lost along the way, often things that might be more important. But at what cost? Every gain has a receipt. The question is: what did you really pay? And was the gain worth the price?
What we pay: From ambition to immigration
To earn the big payout, there is always a price but there comes a time of asking what it will be. For athletes, politicians, actors or musicians there is a cost. Sometimes the cost or “bill” is clear much later, and arrived in the form of strained health, lost relationships, and broken promises. Firsthand experience (SP) tells us that ambition and success can create a hefty debt. And that debt engulfed in a surge of endorphins (our internal opioids that mask the pain). We lose the ability to know how far is too far. And then there is not only internal exhaustion but collateral damage to others that came along for the ride with their own expectations of pain and gain. By then the question is not whether there was a gain, but whether it was worth the cost.
The immigrant ledger shows this clearly: generations traded proximity to family and peace of mind for prosperity — but the tax of ambition only grew heavier with time. The earliest immigrants came to America with this entrepreneurial spirit but endured enormous pain at home at work and in public. This involved loss of contact with family at the expense of the hope of economic prosperity. That same zeal has been passed on to subsequent generations but magnified. Bigger houses, more expensive cars, more vacations but at what cost? What was the tax that was paid either in the form of health, or relationships or peace of mind to achieve all that and what was the net gain or loss.
The hidden balance sheet
Whether the pain is physical, emotional and intellectual, each form of pain involves some element of loss — real or perceived. But what if pain is more than just a temporary cost on the ledger of life? What if it is a state of losing something more important like health, identity, security, or peace of mind that is not always balanced by an equal gain? Thinking about pain through the metaphor of finance reveals its hidden weight.
Every life has debits and credits, moments of loss and moments of fulfillment. Pain enters the account when expectations are unmet, when the return on effort falls short of the investment, or when outcomes fail to justify the sacrifices. In that sense, pain is not only personal but also transactional, tied to the deficits between what we give and what we receive. Sometimes that deficit is created by the difference between ego and expectation (as we explored here).
The difference in the balance sheet of pain is that some of the assets are intangible. There is no way to quantify what health, family or peace is worth. So, while we pursue through pain with hopes of quantifiable gain be it monetary, or followers, or likes, or wins, it’s hard to reconcile against the cost of health, family and peace.
Emotional debt
That same dynamic — the gap between ego and expectation — shapes much of how we experience pain today. Across communities, the balance sheet of pain is growing heavier, and it extends far beyond biology. Mental health challenges like depression, anxiety, and stress-related disorders represent silent liabilities. The American Psychological Association has documented how stigma prevents people, particularly immigrants and members of minority communities, from seeking help. These emotional debts accumulate, and because they remain invisible, they can be even more destabilizing. In fact, a part of the brain responsible for emotional regulation, the amygdala, fires most not when we win but when we face the loss. Biology seems to over index on the pain side of the ledger.
Distortions in the digital age
In today’s world of ChatGPT and social media, the risk grows sharper. Tools like ChatGPT can become ways to deflect or ignore pain, while social platforms offer fleeting credits of validation that often create larger withdrawals of self-worth. They can also worsen the impact of cognitive distortions that can occur when we rely on AI and technology to fill in the blanks. From another perspective, our dependence on ChatGPT and AI may be a way of alleviating our pain but reducing gain. It is easier to delegate our work and not have to endure the pain of writing a condolence note or thinking. The gain in efficiency, then, is balanced by a loss in creativity and literal loss of neural connections.
As we explored in our last piece, GenAI tools can also worsen the impact of cognitive distortions that occur when we rely on technology to fill in the blanks. Just as our own minds rush to fill gaps, AI can reinforce distortions — offering speed and certainty while quietly eroding depth and clarity.
Social media presents a parallel trap. It is fleeting credits of validation but often results in larger withdrawals of self-esteem and belonging, as comparison fuels anxiety and inadequacy. Social media does not just help us mask pain — it encourages us to engage in it because it monetizes pain. Platforms reward outrage, comparison, and controversy, conditioning us to seek the very triggers that wound us. In a way, we “invest” in pain online, too. The cost is often much higher than the return. These feelings accumulate silently until they demand to be reckoned with.
Emotional literacy: Spending pain wisely
Pain may be inevitable, but suffering in silence is not. Just as financial literacy helps us manage money, emotional literacy helps us manage pain. Its literacy about understanding the cost benefit analysis of enduring situations we choose. Being aware of the decisions we make deliberately to endure pain and the signals to slow down are critical.
In his book, Dr. Gupta raises the importance of “bringing attention to the physical pain as a means of mitigation.” Hindu scripture is also replete with the idea that controlling our thoughts and emotions is pivotal in how we manage pain and suffering. Both focus on awareness, control, and detachment.
Choosing not to swing on the pendulum but to give our best in every effort and then “let go” free of attachment to the outcome. Free of anxiety or fear. Of course, some debits in life are unavoidable, but others are self-imposed by the burdens of comparison, ambition, and pride, the ego’s hidden tax.
Our call to awareness is an invitation to consider what is in our control and how to balance our ledgers. Recognizing the debits and valuing the credits may not eliminate pain, but it can help us manage it more wisely, and with greater compassion for ourselves and for those around us. We cannot eliminate pain. But like money, we can learn to spend it wisely, with intention and compassion.
(Sreedhar Potarazu, MD, MBA, is an ophthalmologist, healthcare entrepreneur and author with more than two decades of experience at the intersection of medicine, business, and technology.
Carin Isabel Knoop is a management researcher who leads the Case Research & Writing Group at Harvard Business School. She is the co-author of “Compassionate Management of Mental Health in the Modern Workplace (Springer).”)