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Thoracic Epidural Steroid Injections in NYC

A thoracic epidural steroid injection (cortisone shot) can provide immediate relief for a wide range of painful conditions in your upper and middle back. Common conditions such as neck pain and shoulder discomfort often are relieved after one or two cortisone shots. Our pain specialist provides this treatment in his Manhattan sports medicine office for your convenience. Our sports injury therapy clinic in Midtown NYC is certified and approved and is among the best pain management clinics in New York and the region.

Thoracic Epidural Injection in NYCA thoracic epidural steroid cortisone injection is a treatment designed to relieve pain in the upper back and shoulder areas. The specific pain could result from severe inflammation or a pinched nerve in the thoracic region of the spine, which comprises your upper and back middle areas. Thoracic epidural cortisone steroid injections reduce inflammation in the affected area and provide pain relief.

The cortisone injection is a way to deliver steroids and anesthetics right into the nerves in the spinal roots, providing immediate pain relief. Your Midtown Manhattan sports medicine and pain management doctor uses cortisone injections as temporary pain relief to give your body time to heal. The thoracic epidural steroid cortisone injection (cortisone shot) is highly effective and significantly reduces pain more than 50 percent of the time.

Reasons You May Need a Thoracic Epidural Cortisone Steroid Injection

Back pain is one of the main complaints your doctor hears for many reasons. Whether you’re an active weekend golfer, a professional athlete, or a worker who sits in front of a computer all day, you can develop thoracic spine pain.

Common causes that lead to your need for thoracic epidural cortisone steroid injections include:

Diagnosing Your Thoracic Spine Pain

Prepare to give your doctor details about any trauma you may have had recently that seemed to coincide with your back pain. A thorough history of previous back problems and your activity level also help him reach a clear diagnosis.

Diagnostic tests may include x-rays, CT scans, or MRIs, which can help your doctor rule out other causes of pain, such as tumors. If you’re pregnant, taking blood thinners, or have an infection, you may not be eligible to receive a thoracic epidural cortisone shot.

Cortisone Shot: What to Expect

The procedure is beneficial for all kinds of diagnoses, including upper back pain, middle back pain, and back injuries that cause thoracic back pain.

For your safety, don’t take any pain relief or anti-inflammatory medications before the procedure. Talk to our top-rated sports medicine specialist in NYC about what to eat and what medications are allowed before the cortisone shot. The steps taken for the thoracic epidural steroid injection include:

  1. You’re asked to lie on your stomach on a fluoroscopy table that provides real-time x-rays to help your doctor diagnose the needle. You may be offered a sedative to relax during the procedure if you’re nervous.
  2. The area of the cortisone injection site is then cleansed and sanitized with an antibacterial solution and prepped for the initial injection.
  3. A numbing agent is applied to the cortisone injection site, so you don’t feel the needle. The numbing agent might give you a slight sting.
  4. Next, the needle with the medication is injected into the spot deemed to be the source of your pain.

The entire procedure very often takes just 10 minutes or less. After the procedure, you’re asked to stay in the recovery room for anywhere from 15 to 60 minutes for observation. It’s normal to feel slight discomfort or soreness in the area of the cortisone shot. An ice pack at home for the first day or two helps alleviate this soreness.

After Cortisone Shot Treatment and Recovery

Within about 48 to 72 hours of your thoracic epidural cortisone steroid injection procedure, the effects of the treatment begin to take effect. You receive the intended relief in the injured part of your spine.

Follow-up appointments are necessary with your Manhattan pain management doctor because thoracic epidural steroid cortisone injections typically are done in a series of three shots, each about two weeks apart, depending on the severity of your pain and the success of the first epidural.

I had a ton of back pain when I went in, and Dr. Melepura recommended that I get an epidural. My pain level dropped within minutes, which hadn't happened in a very long time! Regards to Dr. Melepura and team for their excellent care!

Rowan Oconnell

Side Effects and Benefits

You may experience immediate pain relief in your upper back and shoulders, indicating that the injection was put in correctly. If pain continues, however, during the following days, and a tender or sore feeling returns to the location of the cortisone shot, you may be experiencing a rare side effect that could include:

  • Bruising
  • Swelling at the site of the cortisone injection
  • Increasing local pain
  • Infection
  • Facial flushing
  • Nerve damage

Most of these side effects usually dissipate within 24 hours. Thoracic epidural steroid injections or cortisone shots are safe and highly effective, but serious side effects can occur. Call your doctor if you experience:

  • Headaches while you’re standing or sitting up that feel better when you lie down
  • Fever that lingers for more than 24 hours
  • Losing bowel or bladder control
  • Loss of arm or leg function
  • Severe pain

Frequently Asked Questions

What Is an Epidural Injection?

An epidural steroid injection is an effective non-surgical treatment intended to treat pain in a particular region of your body, from your neck to your tailbone. The thoracic epidural steroid injection relieves upper back pain shooting around your chest caused by irritated and inflamed pinched nerves.
The procedure involves injecting a local anesthetic (numbing medicine) and steroid medication into the epidural space through which the inflamed nerves travel. The epidural space is located outside the outermost layer enveloping your spine.

How Does an Epidural Work?

An epidural works by alleviating inflammation (swelling) of the nerve roots as they exit your spine. These nerves go through the epidural space to your upper back and chest. Inflammation of these nerve roots can be caused by a herniated disc or narrowing of the areas within your spine.
Steroids are anti-inflammatory agents. By delivering an anti-inflammatory medication directly into the epidural space, the epidural injection reduces the inflammation of the nerve roots.

Where Is the Epidural Performed?

The epidural steroid injection is performed in the office in our X-ray room.

Where Is the Epidural Injection Site?

A thin, flexible needle is inserted through your upper back, slightly off the midline, to reach the epidural space, which contains inflamed and irritated nerve roots.

What Conditions Do Epidural Injections Treat?

An epidural shot can treat several conditions that cause upper back or chest pain due to nerve irritation. The common conditions that epidural injections treat are disc herniation, thoracic stenosis, and facet joint arthritis. Thoracic disc herniation is when your disc’s inner, jelly-like core forces through the outer ring into the spinal canal. This may be compressing your spine and nerves, which triggers nerve root pain spreading around your chest(known as radicular pain). Thoracic spinal stenosis is narrowing your spinal canal (that contains the nerve roots and spinal cord) in the thoracic area. It gives rise to pain in the upper back and tingling in the chest, especially if you are sitting for a long time. Facet joint arthritis is when your small joints between two spinal bones (facet joint) develop inflammation, causing upper back pain that can go around your chest.

How Is Epidural Injection Done?

We use a specialized X-ray (called fluoroscopy) with a special laser to guide the needle into the right spot. You will lie on an x-ray table on your stomach. After thoroughly cleaning, a local anesthetic is first used to numb the targeted site. The site is targeted by lasers, which we use throughout the procedure to guide the needle precisely where it needs to be. A needle is then inserted into the epidural space with an x-ray fluoroscopy. Fluoroscopy directs the needle to reach the targeted spot by enabling the doctor to view and adjust the position of the needle in real time on an x-ray monitor. Once the needle is in the proper place, as seen on the monitor, contrast (dye) is injected to verify the needle’s location and guide the steroid to the desired site. The steroid is then slowly injected with the anesthetic to help minimize swelling around nerve roots and relieve the pain. The needle is then finally removed. The whole procedure will occur for 5-6 minutes.

How Long Will I Be Here During My Procedure?

Following the procedure, we will monitor you for potential complications for about 15 to 20 minutes before discharge.

Are Epidural Injections Safe?

Epidural steroid injections are generally considered a safe and effective treatment for back and leg pain, mid-back pain, or neck and arm pain. Serious adverse events are rare but could include bleeding, infection, or nerve damage. We greatly minimize these risks by using live fluoroscopy, laser guidance, and contrast dye to place the needle in the epidural space accurately.

What Are the Side Effects of an Epidural Injection?

Some patients experience soreness in the treated area. This pain usually occurs when the local anesthesia wears off while the steroids have not started to take effect yet. You can manage this soreness by applying ice packs and taking a low dose of Tylenol. Rare complications include bleeding, infection, and headaches. Side effects of steroids are “Steroid flush” or transient flushing of the face and chest, raised blood sugars, sleep issues, menstrual problems in women, and water retention. These side effects are rare since we use a small number of concentrated steroids. The side effects resolve within 2-3 days without any treatment.

Does an Epidural Cause Weight Gain?

Epidural injections do not cause weight gain. However, long-term use of high-dose steroids has widespread adverse effects on almost all your body systems, including body weight. This is why we limit the number of epidural steroid shots a person can receive in a year.

What Is the Recovery Like After Getting Epidural?

Epidural steroid shots are successful in the most upper back or chest patients. The steroid injection can take as long as 2-10 days. You may have slightly increased pain at the injection site during this period until the steroid medication kicks in. You are asked to take it easy on the day of the procedure. You will be okay to resume all your regular activities the following day.

What Can I Do After My Procedure?

After your discharge, it’s best to rest and relax for the rest of the day. If you have pain at the injection site, apply an ice pack to that area. You can resume all normal activities the next day.

Can I Shower After an Epidural Injection?

You may shower on the same day. However, avoid soaking in a bathtub, using a hot tub or sauna, or swimming for at least two days after your procedure.

Do Insurance Companies cover epidural Injections?

All insurances cover epidural injections, especially if you have a lot of pain that has not been getting better with conservative treatment like non-steroidal anti-inflammatory drugs (like ibuprofen), exercise therapy, and lifestyle modifications.

How Often Can Epidural Steroid Injections Be Given?

An epidural steroid injection can be given 3-4 times per 12-month period. By optimizing the first epidural to be as effective as possible, we try to avoid repeating the injection. We only repeat the procedure if there is a need to, which will be discussed during your follow-up visit.

Do you have any questions about the thoracic epidural injection or cortisone shot we offer in NYC? Would you like to schedule an appointment with the best-rated pain doctor Febin Melepura MD of sports pain clinic NYC? Please contact our office for a consultation with the top pain relief specialist in Midtown Manhattan.

Page Updated on Oct 28, 2022 by Dr. Melepura (Pain Management Doctor) of Sports Injury & Pain Management Clinic of New York Sports Injury & Pain Management Clinic of New York
36 W 44th St #1416
New York, NY 10036
(212) 621-7746
Sports Injury and Pain Management Doctor NYC - Febin Melepura, MD

Febin Melepura, MD is a top rated, best in class interventional pain management doctor. He is a nationally recognized pain relief specialist and is among the top pain care doctors in New York City and the country. He is an award winning expert and contributor to a prominent media outlets.

Dr. Febin Melepura has been recognized for his thoughtful, thorough, modern approach to treating chronic pain and, among other accolades, has been named a “top pain management doctor in New York”, and one of “America’s Top Doctors™” for an advanced sports injury treatments.

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