Thoracic Epidural Injection

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What is a thoracic epidural injection?

A thoracic epidural injection is a shot that helps ease pain for a short time in your upper to middle part of your back (thoracic region). Medicine is injected into the epidural space. This is the area around your spinal cord.

Your spinal cord is a delicate bundle of nerves that runs from your brain to your lower back. The nerves of the spinal cord let your brain communicate with the rest of your body. The epidural space surrounds the spinal cord. The spine or backbone is the hard structure made of a column of many small bones (vertebrae). The bones of the spinal column help protect your spinal cord from injury. Between these bones are intervertebral disks. These disks cushion the vertebrae. They also give your backbone flexibility.

Sometimes, nerves leaving the spinal cord can become pinched or inflamed. That might happen, for example, if part of an intervertebral disk presses into the space of the spinal cord and nerves. Or it may happen with a herniated or ruptured disk, or a deteriorating disk. You may then feel pain in your back.

Why might I need a thoracic epidural injection?

If you have middle or upper back pain, your healthcare provider may first suggest other treatments. These involve pain medicine and physical therapy. If these treatments don’t work, a thoracic epidural shot might make sense for you. It may be best if you have had moderate to severe pain for at least 3 months.

A thoracic epidural injection may ease pain for several types of back problems such as:

Injuries causing irritation of the spinal nerves
Thoracic disk herniation with pain spreading into your back or arm
Thoracic post-surgical spine syndrome
Thoracic spinal stenosis

The shot may reduce swelling around the spinal nerve roots. It can help ease your pain in the area for weeks to months.

Healthcare providers may sometimes use this type of shot to help find the source of back pain. In that case, you might get a shot of pain medicine. If you feel instant relief, it can help your healthcare provider confirm the source of your pain.

What are the risks of a thoracic epidural injection?

A thoracic epidural is a fairly safe procedure. But it does carry some risks. To help reduce these problems, healthcare providers often use X-rays to guide them. Possible risks are:

Bleeding
Headache from unintentionally putting the needle into the spinal cord
Infection
Rash because of an allergic reaction
Short-term increase in pain
Short-term nerve paralysis

There is also a chance that the shot won’t ease your pain.

Your own risks may differ. They depend on your age, your overall health, and the reason for the shot. Talk with your healthcare provider about your specific risks.

How do I get ready for a thoracic epidural injection?

Your healthcare provider will tell you how to get ready for your shot. Be sure to tell him or her about:

Any past problems with contrast dye or allergies to medicines
Any recent symptoms, such as a sudden fever
Any medicines you are taking, including over-the-counter pain relievers, such as aspirin
If you are pregnant or think you might be
Your health history

You may be told not to eat or drink anything for several hours before your procedure. You may need to stop taking some medicines. You should also have someone there to drive you home afterward.

You may need other tests before you get the shot. For example, an MRI may give more information about the structure of your back.

What happens during a thoracic epidural injection?

Your healthcare provider can tell you exactly what to expect. In general:

You’ll lie on your stomach or your side for the procedure.
You might be given medicine to make you feel relaxed and sleepy during the procedure.
Your healthcare provider will clean and numb the part of your back where the needle will be inserted.
Continuous X-rays (fluoroscopy) may be used to help your healthcare provider place the needle in the right place.
When the needle is in place, your healthcare provider may inject a contrast material. It will help him or her see exactly where to put the medicine.
Your healthcare provider will slowly inject the medicine. It’s a combination of pain and anti-inflammatory medicines. The shot itself might feel slightly uncomfortable. You may also feel some pressure. Some people have a “pins and needles” feeling. That is normal. But you shouldn’t feel pain. Tell your healthcare provider if you feel any sharp pains.

What happens after a thoracic epidural injection?

After the procedure, you typically will need to wait a short while before going home. Your healthcare provider can then watch for any reactions to the shot. You should be able to go back home within the hour. You may need to take it easy for the rest of the day. But you should be able to go back to your normal activities the next day. If you took medicine to help you relax, you shouldn’t drive or make any big decisions for at least 24 hours.

You may not notice any improvement right after your shot. Some people even feel a little worse afterward. The shot may take as much as a week or so before it starts to ease the pain. Any benefit may last for a few months. If the shot controls your pain while your back is slowly healing on its own, the pain may not return at all.

You might feel some numbness in your arms. But that should go away within a few hours. Let your healthcare provider know if you have any side effects. These may include warmth and redness at the injection site or continued numbness. Your healthcare provider may give you more directions about what to do afterward.

After the procedure, you will need to see your healthcare provider. You may need follow-up imaging or blood tests. Your healthcare provider can also help with making an ongoing treatment plan for your health problem. Though a thoracic epidural shot can help treat pain, it often doesn’t address the problem causing the back pain. You may need other treatments for your pain, like back exercises. You may also need more shots.