Background: There is a paucity of literature on the use of epidural injections for the treatment
of chronic mid and upper back pain due to disc herniation and radiculitis, axial or discogenic pain,
spinal stenosis, post surgery syndrome, and post thoracotomy pain syndrome.
Study Design: A systematic review of therapeutic thoracic epidural injection therapy for chronic
mid and upper back pain.
Objective: The objective of this systematic review is to determine the effects of thoracic
interlaminar epidural injections with or without steroids, with or without fluoroscopy, and for
various conditions including disc herniation and radiculitis, axial or discogenic pain, spinal stenosis,
post thoracic surgery syndrome, and post thoracotomy pain syndrome.
Methods: The available literature on thoracic interlaminar epidural injections with or without
steroids in managing various types of chronic mid and upper back pain was reviewed. The quality
assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review
Group criteria as utilized for interventional techniques for randomized trials and the criteria
developed by the Newcastle-Ottawa Scale criteria for observational studies.
The level of evidence was classified as good, fair, or limited (or poor) based on the quality of
evidence developed by the U.S. Preventive Services Task Force (USPSTF).
Data sources included relevant literature identified through searches of PubMed and EMBASE
from 1966 to March 2012, and manual searches of the bibliographies of known primary and
review articles.
Outcome Measures: The primary outcome measure was pain relief (short-term relief = up
to 6 months and long-term > 6 months). Secondary outcome measures were improvement in
functional status, psychological status, return to work, and reduction in opioid intake.
Results: For this review, 17 studies were identified, including studies examining adverse reactions.
Only 2 studies were included: one randomized trial and one non-randomized or observational
study.
The results of this systematic review evaluating the effectiveness of thoracic epidural injections
with or without steroids in managing chronic thoracic pain shows fair evidence with one
randomized trial in patients with various causes; whereas the evidence is limited based on one
non-randomized study evaluating chronic pain in post thoracotomy syndrome.
Limitations: The limitations of this study include paucity of evidence.
Conclusion: The evidence based on this systematic review for thoracic epidural injection in
treating chronic thoracic pain is considered fair and limited for post thoracotomy pain.
Key words: Spinal pain, chronic mid back pain, chronic upper back pain, post-thoracotomy pain,
thoracic epidural injection, radiculopathy, herniation, steroids, local anesthetic, epidural steroid
Complete recovery of consciousness in a patient with decorticate rigidity following cardiac arrest after thoracic epidural injection
