Epidural injections are a non-surgical treatment option for upper back (thoracic) pain. The procedure involves delivering pain-relieving medications directly to or near the source of the pain in the spine during a short outpatient procedure. Epidural injections can be very effective for some people and may be repeated over time. For some, physical rehabilitation is possible once the pain has been relieved.
Your thoracic spine is located in your chest area. Twelve bones (vertebrae) make up the thoracic spine. A disc between each bone allows movement and acts as a shock absorber. The opening in the center of each bone forms the spinal canal.
Your spinal cord is located within the protective spinal canal. The spinal cord extends from the brain and is a major part of your nervous system. The spinal cord does not fill the entire space in the spinal canal. Instead, the spinal cord is surrounded by the epidural space (cavity), which contains tissue, nerves, and blood vessels.
Spinal nerves extending from the spinal cord travel out of the thoracic spine to exchange nerve signals with your brain about specific parts of your body. The nerves at the thoracic level travel to the chest, middle back, and hands, sending information about sensation and movement. Thoracic level nerves supply your internal organs and the muscles that move the ribs when you breathe.
Thoracic epidural injections are used to treat pain associated with disc rupture (herniation) or disease, trauma, fracture, cancer, and curvature of the spine (scoliosis). Thoracic epidural injections can be helpful for nerve conditions associated with diabetes (diabetic neuropathy), shingles (post herpetic neuralgia), and of unknown origin (idiopathic thoracic neuralgia).
The symptoms that you experience depend on the cause of your back pain. Generally speaking, nerve irritation in the thoracic spine can cause upper back pain, rib and chest pain, and rarely, pain in the abdomen.
Your doctor will examine you and conduct tests to determine the cause of your thoracic back pain. Imaging tests, lab tests, and nerve studies may be used to provide your doctor with more information. Your doctor will let you know if epidural injections are a treatment option for you.
Epidural injections are used to place local anesthetics and/or steroids directly near the source of pain and inflammation. The medication is injected in the epidural space of the spinal canal. Steroid medication is used to reduce inflammation and relieve pain. A salt water (saline) solution may be added to flush chemicals that cause inflammation. Short or long acting anesthetic medications are used to relieve pain, such as that associated with shingles or cancer.
Epidural injections are short outpatient procedures that can be given at a surgery center, hospital, or your doctor’s clinic. You will wear a gown for the procedure. You will be positioned sitting up or lying down. Before you receive the epidural injection, the injection site on your back will be sterilized and numbed with an anesthetic. You may receive relaxation medicine before your procedure begins.
Your doctor will use a live X-ray image (fluoroscopy) to carefully insert and guide the needle to the epidural space. A contrast dye is used to confirm the needle placement. Next, the medication solution is delivered to the epidural space, and the needle is removed.
You will be monitored for several minutes before you can return home. Your doctor will instruct you on how to relieve temporary mild pain at the injection site. It is common to experience an initial slight increase in pain, followed by pain relief in a few days.