- Upper back pain
- Middle back pain
- Chest wall/rib pain
The spinal cord and its nerves are protected by a covering called the dura. The space around the dura is called the epidural space. The thoracic area of the spine has 12 bones or vertebrae. Soft discs between these vertebrae hold them together, cushioning them and controlling motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.
Upper back pain when you move your head may mean thoracic disc and dural inflammation. If your pain travels to the front of your chest you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.
A thoracic epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. When it is done from the side it’s considered a transforaminal injection, and medication is placed near the source of inflammation. The injection may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.
You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot. It is normal for your pain to return after this initial pain- free period, and it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.
The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired.