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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.


  • 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.


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