4747 E. Camp Lowell Drive
Tucson, AZ 85712
Ph: (520) 731-5540   
Fax: (520) 731-5541

 
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Caudal Epidural Steroid Injection
Cervical Epidural Steroid Injection
Discography
Facet Joint Injection
Intrathecal Pump Implant
Intercostal Nerve Block
Lumbar Epidural Steroid Injection
Lumbar Radiofrequency Neurotomy
Lumbar Sympathetic Block
Lumbar Transforaminal Epidural Steroid Injection
Medial Branch Block
Neuromodulation
Stellate Ganglion Block


Caudal Epidural Steroid Injection

Steroid injections into the sacral epidural space through an opening at the base of the spine, just above the tailbone or coccyx are useful in patients with certain types of low back and leg pain. This technique is particularly useful in patients who have had previous back surgery. Medications injected through the caudal approach distribute through the epidural space and bathe the inflamed nerve structures in a mixture of local anesthetic, anti-inflammatory medication, and steroid solution to attempt to decrease inflammation and pain. Sometimes your doctor may advance a catheter (tube) through the needle to place medication higher up in the back. This procedure is typically performed with x-ray (fluoroscopic) guidance to lessen the risks to the patient as well as to ensure that the medication goes where intended. Patients may expect to return to work the next day.
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Cervical Epidural Steroid Injection

Herniated discs, bony overgrowth from aging and arthritis, and other degenerative changes to the spine of the neck can all cause pain in both the neck, shoulders, and arms. These changes can compromise and irritate the spinal cord or nerve roots that supply the arms, causing pain. This is what people sometimes refer to as a “pinched nerve” in the neck. By placing a mixture of steroid and local anesthetic as well as certain anti-inflammatory medications in the vicinity of these neural structures, the swelling and inflammation can be reduced which may decrease the pain. This procedure is typically performed with x-ray (fluoroscopic) guidance to lessen the risks to the patient as well as to ensure that the medication goes where intended. Patients may expect to return to work the next day.
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Discography

The inter-vertebral discs are soft rubbery elastic tissues that separate the vertebral bodies. The discs serve as both hinges and shock absorbers. As we age, these discs can begin to deteriorate and may themselves become a source of pain.

Discography, or provocative discogram, is a diagnostic tool that allows the identification of an inter-vertebral disc that is thought to be causing pain. Under x-ray guidance needles are placed into the suspect disc as well as the discs above and below, and each disc is incrementally pressurized. This procedure replicates the pressurization of the disc that occurs when the patient stands up, but allows pressurization of only one disc at a time, allowing for the identification of a diseased disc. The patient is asked to describe the nature and exact location of any resultant sensations. If pain that is concordant (the same as) the patient’s usual pain develops with disc pressurization, this suggests a diseased disc that may respond to further intervention. Typically the patient will be sent for a CT scan after this procedure to assist in the identification of abnormal disc anatomy. Patients may expect to return to work the next day.
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Facet Joint Injection

The facet joints allow the spine to twist and turn from the neck all the way down to the low back. These joints also help in supporting the body’s weight. Aging, normal wear and tear, athletics, trauma, and arthritis all cause pain in the facet joints. Facet joint pain most commonly occurs near the spine but can refer pain to the extremities as well.

There are at least two reasons to perform facet joint injections. The first is that the injections are therapeutic in that they place steroids into the facet joints, which can decrease the joints’ inflammation and reduce pain. The second is that the injections can help determine the specific source of a patient’s pain. If a patient’s usual pain is eliminated by the injections, this verifies that the pain is coming from an injected joint. These procedures are performed under x-ray guidance to ensure that the correct levels are injected and that the medicine is placed into the joint itself. Patients may expect to return to work the next day.
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Intrathecal Pump Implant

At Rincon Pain Management, these devices typically are placed only in cancer patients or patients with severe spasticity symptoms. Implantable drug delivery systems are surgically implanted beneath the skin of the abdomen or buttocks and a catheter is implanted into the cerebrospinal fluid next to the spinal cord. The implanted drug delivery pump continuously infuses medication next to the spinal cord to control undesirable symptoms. These procedures are typically performed in a hospital or surgery center operating room with an anesthesiologist caring for the patient during the procedure. Usually the patient will be able to go home after the procedure, but may rarely need to spend a night in the hospital after this procedure.
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Intercostal Nerve Block

Pain involving the ribs or chest wall can often be controlled by blockade of the nerves that supply these areas. A mixture of local anesthetic and steroid is injected into the area surrounding the affected nerves. This procedure may be repeated if the symptoms return. One of the primary risks of this procedure is pneumothorax, or air leakage outside of the lung itself. Any patient who has recently undergone an intercostal nerve block who has difficulty breathing our shortness of breath should call the doctor who performed the procedure or go to the nearest Emergency Room.
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Lumbar Epidural Steroid Injection

Lumbar epidural steroid injections are used to treat low back and lower extremity pain caused by degenerative changes to the low back including the vertebrae (bones) and intervertebral discs. To perform this procedure successfully, the patient is thoroughly examined in clinic and the history of the pain as well as all available x-rays are reviewed. In addition, the patient’s medical history and medications are reviewed. While seems like a lot of work, it is crucial to ensure that the medication is delivered to the correct region of the spine. Injections can be delivered at one or multiple levels of the spine, and can also be directed towards the front or back of the spinal column as well as to either side. While many other providers do not take the extra time to review all of this information, our high success rates with epidural steroid injections confirms that the additional diagnostic effort on our part is worthwhile!

This procedure is typically performed with fluoroscopic (x-ray) guidance to lessen the risks to the patient as well as to ensure that the medication goes where intended. Patients generally can return to work the day after the procedure.
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Lumbar Radiofrequency Neurotomy

When a set of nerves that supply a facet joint in the spinal column are identified as the source of pain, these nerves may be targeted for a long-acting nerve block to decrease or eliminate the pain. This procedure is typically performed with fluoroscopic (x-ray) guidance to lessen the risks to the patient as well as to ensure that the correct nerves are blocked. A special needle is placed adjacent to the problem nerve(s), and the tissues surrounding the needle tip are heated using high intensity radio waves. The patient does not usually feel this occurring as local anesthetic has been injected in the area before the radiofrequency procedure commences. The procedure begins to provide pain relief within 4-6 weeks, and the procedures last from 6 months to forever, with the average patient experiencing relief for 1-2 years. If the pain returns, the procedure can be repeated. Patients can typically return to work on the day following the procedure, but may be sore at the injection sites.
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Lumbar Sympathetic Block

In certain types of lower extremity and pelvic pain, the nerve center, or plexus that controls autonomic function (primitive nerve functions) can become involved in the transmission of pain signals. These autonomic nerves control functions in the legs and pelvis such as whether the skin has goose bumps when it is cold or is sweating when it is warm. Blocking these nerves that lie just in front of the spine can reset some of these nerves as well as block some other pain nerves that have become involved in pain transmission. This procedure is typically performed with fluoroscopic (x-ray) guidance to lessen the risks to the patient as well as to ensure that the medication goes where intended.
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Lumbar Transforaminal Epidural Steroid Injection

This procedure places a needle in the epidural space in close proximity to the intervertebral disc and the spinal nerve roots. This placement allows the delivery of a mixture of local anesthetic and steriod to reduce inflammation and pain that has resulted from degenerative changes in the spine. This procedure is typically performed with fluoroscopic (x-ray) guidance to lessen the risks to the patient as well as to ensure that the medication goes where intended. Because the needle is directed toward a specific nerve root, this procedure is often selected more for pain that is concentrated off to one side or the other as opposed to the middle of the back. Most patients return to work the next day.
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Neuromodulation

Stimulation of nerves that cause pain has been in use for years to allow the management of complex pain problems that have not responded to more conservative therapies. Often the nerve or nerves, either in the periphery or at the level of the spinal cord can be blocked in such a way as to prevent pain signals from reaching the brain. This typically involves the implantation of a computer controlled electrical device that allows your doctor to "pace" the diseased nerves that are involved in sending pain signals from the body to the brain. If a trial procedure is successful in managing the pain, the battery and electrical leads will be permanently implanted beneath the skin to allow long-term pain control. This procedure is typically performed in an operating room setting as an out patient procedure. Our office stocks informational videos on spinal cord and peripheral nerve stimulation. Ask your doctor for a consultation to see if neuromodulation is an option for treating your pain.
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Medial Branch Block

Medial branch block is used to diagnose the origin of low back or neck and shoulder pain. The facet joints are fingernail sized, paired joints found on either side of the spine. Disease of the facet joints, particularly in the neck, may not show up on X-ray, CT, or MRI. The nerves supplying these joints are called the medial branch nerves. Medial branch block is a diagnostic test in which the nerves that supply the diseased facet joints are anesthetized temporarily. This is performed under x-ray guidance. A needle is placed next to these nerves, and a small amount of local anesthetic is injected to perform the block. If the pain improves after this block is performed, the patient will likely be scheduled for a radiofrequency neurotomy to prevent these nerves from continuing to send pain signals to the brain. Remember, this nerve block is only a diagnostic test and does not provide long-term pain relief. If the pain is improved after the block, then this is considered a successful diagnostic medial branch block. Patients who experience appropriate relief after a medial branch block will generally be scheduled for a more long-acting procedure.
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Stellate Ganglion Block

The stellate ganglion is a nerve complex in the neck that controls autonomic function in parts of the face and arms. These autonomic functions include whether the skin is warm or cool to the touch, as well as responses like sweating and goose bumps. In certain conditions, the nerves from the stellate ganglion as well as some nearby nerves can become involved in the transmission of pain signals from the face and arms to the brain. Blocking these nerve signals can produce dramatic and sometimes long-term relief of pain. This block is usually performed under X-ray guidance to minimize the risks to the patient. After receiving this block, the patients will often notice several common side effects. These include an enlarged pupil and drooping eyelid on the side that was blocked, a hoarse voice, and the sensation of having a lump in the throat. These are normal responses to stellate ganglion block and will resolve in 8-12 hours. Patients usually return to work the day after this procedure.
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