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Essentials of Interventional Techniques in Managing Chronic Pain pp 187–208Cite as

Thoracic Epidural Injections

Abstract

The prevalence of mid- and upper back chronic pain is significantly lower than low back and neck pain with reports showing pain of thoracic origin in 5–15% of the patients, compared to 24–44% with neck pain and 33–56% with low back pain. Thoracic intervertebral discs, nerve roots, and facet joints are capable of transmitting pain in the thoracic spine with radiation into the chest wall and abdominal wall. Chronic, persistent thoracic and chest wall pain and radicular pain may be secondary to disc herniation, discogenic pain, spinal stenosis, or post-thoracic surgery syndrome.

Epidural injections are one of the commonly utilized treatment modalities for managing chronic thoracic pain administered by either interlaminar approach or transforaminal approach. There is significant paucity of literature concerning thoracic epidural injections in managing chronic pain, with only one high-quality randomized controlled trial, leading to Level II evidence for thoracic interlaminar epidural injections with no evidence available for thoracic transforaminal epidural injections.

Keywords

  • Mid-back pain
  • Thoracic disc displacement
  • Thoracic spinal stenosis
  • Thoracic postsurgery syndrome
  • Thoracic discogenic pain
  • Thoracic interlaminar epidural injection
  • Thoracic transforaminal epidural injections

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Acknowledgments

This book chapter is modified and updated from a previous book chapter, “Thoracic Interlaminar Epidural Steroid Injections” by Kenneth P. Botwin, MD and Susan Vettichira, MD, in Interventional Techniques in Chronic Spinal Pain published by ASIPP Publishing. Permission has been obtained from ASIPP Publishing.

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Authors and Affiliations

  1. Pain Management Center of Paducah, Paducah, KY, USA

    Laxmaiah Manchikanti

  2. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA

    Laxmaiah Manchikanti

  3. Medical Advanced Pain Specialists Medical Pain Clinics, Shorewood, MN, USA

    David M. Schultz

  4. Pain Specialists of Greater Chicago, Burr Ridge, IL, USA

    Scott E. Glaser

  5. Mid Atlantic Spine and Pain Physicians, Newark, DE, USA

    Frank J. E. Falco

  6. Pain Medicine Fellowship Program, Temple University Hospital, Philadelphia, PA, USA

    Frank J. E. Falco

  7. Temple University Medical School, Philadelphia, PA, USA

    Frank J. E. Falco

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  1. Laxmaiah Manchikanti
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  2. David M. Schultz
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  3. Scott E. Glaser
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  4. Frank J. E. Falco
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Correspondence to Laxmaiah Manchikanti .

Editor information

Editors and Affiliations

  1. Pain Management Center of Paducah, Paducah, Kentucky

    MD Laxmaiah Manchikanti

  2. Department of Anesthesia, LSU Health Science Center, New Orleans, Louisiana, USA

    MD Alan D. Kaye

  3. Mid Atlantic Spine and Pain Physicians, Newark, Delaware

    MD Frank J.E. Falco

  4. Service Line Chief of Interventional Radiology, Director of Interventional Neuroradiology, Chief of NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    MD Joshua A. Hirsch

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Manchikanti, L., Schultz, D.M., Glaser, S.E., Falco, F.J.E. (2018). Thoracic Epidural Injections. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_12

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