Thoracic Epidural Injections

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 (RCT), leading to Level II evidence for thoracic interlaminar epidural injections with no evidence available for thoracic transforaminal epidural injections.