Introduction
Thoracic epidural injections offer a non-surgical treatment option for upper back (thoracic) pain. By delivering pain-relieving medications directly to the source of discomfort, these injections can provide significant relief. The procedure is quick, outpatient, and may be repeated over time if necessary. For some individuals, alleviating pain with epidural injections may facilitate participation in physical rehabilitation and improve overall quality of life.
Anatomy
The thoracic spine is located in the chest region and consists of twelve vertebrae. Between each vertebra is a disc that provides cushioning and enables movement, serving as a shock absorber. These vertebrae form a protective spinal canal that houses the spinal cord, an integral part of the nervous system that transmits signals between the brain and the body.
Surrounding the spinal cord within the canal is the epidural space, which contains tissue, nerves, and blood vessels. Nerves from the thoracic spine branch out to the chest, mid-back, and hands, controlling movement and sensation. These nerves also regulate critical functions such as breathing by controlling the muscles that move the ribs.
Causes
Thoracic epidural injections are often used to treat pain caused by various conditions affecting the thoracic spine. Common causes include herniated or diseased discs, trauma, fractures, spinal curvature (scoliosis), and cancer. These injections can also relieve nerve-related pain from conditions such as diabetic neuropathy, shingles (post-herpetic neuralgia), and idiopathic thoracic neuralgia, where the cause of the pain is unknown.
Symptoms
Symptoms of thoracic nerve irritation can vary based on the underlying cause of the pain. Typically, thoracic spine issues cause upper back pain, but they can also lead to pain in the rib cage, chest, or even, though less commonly, the abdomen.
Diagnosis
To diagnose the cause of your thoracic pain, your doctor will conduct a thorough physical exam and may order imaging tests, lab work, or nerve studies. Once the root cause is identified, your doctor will determine if thoracic epidural injections are a suitable treatment option.
Treatment
Thoracic epidural injections are used to deliver local anesthetics and/or corticosteroids directly into the epidural space of the spinal canal. Steroid medications help reduce inflammation, while anesthetics provide pain relief. A saline solution may also be used to flush out inflammatory chemicals. These injections can help manage conditions like shingles-related pain or pain associated with cancer.
The procedure is brief and can be done in an outpatient setting, such as a hospital, surgery center, or your doctor’s office. You will wear a gown and be positioned sitting up or lying down, depending on your doctor’s instructions. The injection site on your back will be sterilized and numbed with a local anesthetic, and you may receive a mild sedative to help you relax.
Using live X-ray imaging (fluoroscopy), your doctor will carefully guide a needle into the epidural space. A contrast dye is injected to confirm the needle’s placement, followed by the delivery of the pain-relieving medication. Once the injection is complete, the needle is removed.
After the procedure, you will be monitored for a short time before going home. You may experience mild discomfort at the injection site, and your doctor will provide instructions on how to manage this temporary pain. While some patients may initially notice a slight increase in pain, relief generally follows within a few days.
