Airing Pain 53: Headaches, Chilli Pepper Patches and the Placebo Effect

Investigating the diagnoses of headaches, and the benefits of topical and placebo treatments for chronic pain

This edition has been funded by a grant from the Scottish Government.

Paul Evans meets Dr Paul Davies, a Consultant Neurologist from Northampton General Hospital, who explains that whilst most headaches are benign and can be self-medicated, some headaches – those that are frequent and very painful – require medical attention. He outlines the different types of headaches, including migraines, tension headaches and cluster headaches, and says that each kind requires a specific treatment. Dr Davies admits that GPs have a long way to go in diagnosing and treating chronic headaches effectively.

Dr Mick Serpell, a Consultant in Anaesthesia and Pain Medicine in Glasgow, gives us an introduction to topical medicine – medication applied to the surface of the body rather than introduced into it. The medication is applied to the painful area and the drug has a painkilling effect at a local level. Topical medicines can take the form of a cream, a gel or a plaster impregnated with a drug. We hear about two types which are usually used to treat neuropathic conditions – lidocaine and a chilli pepper plaster. One benefit of topical treatments is that they have very few side-effects and can usually be used alongside other analgesics.

Finally, Paul meets Dr Michael Lee, a Research Associate at Oxford Centre for the Functional Magnetic Resonance Imaging of the Brain, who carries out extensive research into placebos ­– treatments given purely for psychological effect. In defiance of those sceptical of the placebo effect, Dr Lee’s brain imaging research shows that placebo medications can have a visible effect on the way that pain is transmitted to the brain. Dr Lee also highlights the importance of psychological context in treatment, saying that what a patient believes about their doctor, their medication and the therapeutic process as a whole affects their response to medication.

Issues covered in this programme include: Migraine, headaches, topical treatment, tension headache, cluster headache, side effects, placebo, psychology, self-medication, gel, cream, plaster, neuropathic pain, blood stream, HIV neuropathy, post-herpetic neuralgia, brain signals and medication.

Contributors:

• Dr Paul Davies, Consultant Neurologist at Northampton General Hospital and runs headache clinic at John Radcliffe Hospital in Oxford
• Dr Mick Serpell, Consultant in Anaesthesia and Pain Medicine in Glasgow
• Dr Michael Lee, Research Associate at Oxford Centre for the Functional Magnetic Resonance Imaging of the Brain.