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What other treatments can help pain caused by osteoarthritis and rheumatoid arthritis?

Q) I'm getting desperate. I suffer from both osteoarthritis and rheumatoid arthritis. My greatest problem is osteoarthritis in my cervical spine. For about five years I've been in constant pain, night and day. My rheumatologist can only suggest exercises, heat, a collar and painkillers (co-codamol), all to little effect. I heard of someone who has Botox injections three times a month, which brings great relief. Could you advise me on this or any other treatment you think would be successful? I'm reaching the end of my tether.
Patricia Robbins, Hale, Altrincham, Cheshire (Spring 2011)

A) I'm sorry to hear about this. Constant pain in the neck is one of the worst types of pain and I know from personal experience how disabling it can be. I've given Botox injections for neck conditions but only if significant muscle spasm is present – this is sometimes referred to as spasmodic torticollis. Botox works by (temporarily) paralysing the muscles. It's a drug derived from the bacteria which cause botulism, where widespread muscle paralysis can occur. It sounds worse than it is and these injections have now been introduced widely in medicine. You've probably heard of their use in plastic surgery. The paralysis isn't permanent but can last for a good while. Often the injections have to be repeated to maintain their benefit. In your case it would be advisable to seek an opinion from someone who administers these treatments. Indeed, other injections are a possibility – selective nerve blocks for example – which are usually given by anaesthetists, working as pain specialists.


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