What is a thoracic epidural injection?

A thoracic epidural injection is a shot that temporarily helps ease pain in your thoracic region. That’s the upper to middle part of your back. Medicine is injected into an area around your spinal cord. This area is known as the epidural space.

Your spinal cord is a delicate bundle of nerves that runs from your brain to your lower back. The nerves of the spinal cord allow your brain to communicate with the rest of your body. The epidural space surrounds the spinal cord. The spine or backbone is the hard structure composed 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 discs. These discs 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 disc presses into the space of the spinal cord and nerves. 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 include pain medicine and physical therapy. If these treatments don’t work, a thoracic epidural injection might make sense for you. It may be best if you have had moderate to severe pain for at least three months.

A thoracic epidural injection may provide pain relief for several different types of back problems, like:

• Injuries causing irritation of the spinal nerves

• Thoracic disc herniation with pain radiating 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 receive 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 usually use X-rays to guide them. Possible risks include:

• Bleeding

• Headache from unintentionally inserting the needle into the spinal cord

• Infection

• Rash because of an allergic reaction

• Temporary increase in pain

• Temporary 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 other medical conditions, and the reason for the shot. It might not make sense for you if you have certain health conditions. These include an infection, a bleeding disorder, or uncontrolled high blood pressure. 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 prepare for your shot. Be sure to tell him or her about the following:

• 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 medical 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 available to drive you home afterward.

You may need other tests before you get the shot. For example, an MRI may provide 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 area of your back where the needle will be inserted.

• X-rays will help your healthcare provider place the needle in the correct position.

• 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 feel a “pins and needles” sensation. 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 rest for the remainder of the day. But you should be able to resume your normal activities the next day. If you took medicine to help you relax, you shouldn’t drive or make any important 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 injection 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 after your injection.

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 condition. Though a thoracic epidural injection can help treat pain, it usually 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 injections.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure