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Thoracic Epidural Injection

What is a thoracic epidural injection?

A thoracic epidural injection is a shot that helps ease pain for a short time. It's done to treat the 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 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 spine flexibility.

Sometimes, nerves that branch off the spinal cord can become pinched or inflamed. That might happen if part of an intervertebral disk presses into the space of the spinal cord and nerves. This can happen if a disk is damaged and part of it leaks and bulges. You may then feel pain in your back.

Why might I need a thoracic epidural injection?

If you have middle or upper back pain, you may first have other treatments. These include pain medicine and physical therapy. If these don’t work, a thoracic epidural shot might be right for you. The shot is for people who have had moderate to severe pain for at least 3 months.

A thoracic epidural injection may ease pain for:

  • Injuries that irritate 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 of the procedure are:

  • Bleeding

  • Headache if the needle goes into the spinal cord

  • Infection

  • Rash from an allergic reaction

  • Short-term increase in pain

  • Short-term nerve paralysis

  • No relief of your back 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. Tell your provider:

  • If you had past problems with contrast dye or allergies to medicines

  • If you have recent symptoms, such as a sudden fever

  • All medicines you take, including blood thinners or 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 for several hours before your procedure. You may need to stop taking some medicines. You should arrange to have someone 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 what to expect. In general:

  • You will lie on your stomach or your side for the procedure.

  • You might be given medicine to make you feel relaxed and sleepy.

  • 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. These help your provider put the needle in the right place.

  • When the needle is in place, your provider may inject a contrast material. It will help them see exactly where to put the medicine.

  • Your provider will slowly inject the medicine. It’s often a combination of pain and anti-inflammatory medicines. The shot itself might feel slightly uncomfortable. You may 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 will need to wait a short time before going home. Your healthcare provider can then watch for any reactions to the shot. You should be able to go back home within 1 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 had medicine to help you relax, don't drive or make any big decisions for at least 24 hours.

You may not feel better right after your shot. Some people even feel a little worse afterward. The shot may take about 1 week to start to ease the pain. The benefits may last for a few months. If the shot controls your pain while your back is healing, the pain may not return at all.

You might feel some numbness in your arms. That should go away within a few hours. Tell your healthcare provider if you have any side effects. These may include warmth and redness at the injection site or continued numbness. Your 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 provider can also help make an ongoing treatment plan for you. A thoracic epidural shot can help treat pain. But it often doesn’t address the problem that caused the back pain. You may need other treatments for your pain, like back exercises. You may also need more shots.

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 you will get the results

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

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

Medical Reviewers:

  • Marianne Fraser MSN RN
  • Raymond Turley Jr PA-C
  • Shaziya Allarakha MD