Thoracic Epidural Injection

A thoracic epidural steroid injection, guided by live X-ray, eases mid-back pain and band-like chest wall pain. It also calms nerve pain that wraps around the chest. Given by our board-certified pain doctors at Remix Medical in Houston, TX.

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By Raju Mantena, DO · Pain Medicine PhysicianReviewed Jul 9, 20262 min read

Key takeaways

A thoracic epidural steroid injection delivers corticosteroid and local anesthetic into the mid-back epidural space under fluoroscopic guidance, calming inflammation around an irritated thoracic nerve root.
Thoracic radiculopathy is far less common than lumbar because the rib cage stabilizes the thoracic spine — but when present it causes distinctive band-like pain wrapping around the chest wall that can mimic cardiac, pulmonary, or abdominal disease.
Because thoracic pain is so often referred from elsewhere, cardiac, pulmonary, and abdominal causes must be excluded before any injection.
The thoracic epidural space is narrow and sits directly over the spinal cord, so the procedure demands meticulous continuous fluoroscopy with contrast confirmation and is performed only by physicians experienced with the anatomy.
It's used for thoracic radiculopathy, uncommon thoracic disc herniation, post-herpetic neuralgia, and post-thoracotomy pain, typically giving weeks-to-months of relief that enables rehabilitation and reduced oral medication.

Thoracic Epidural Steroid Injection in Houston, Texas

The thoracic spine is the least mobile and least commonly injured region of the back, which is exactly why thoracic pain is so often misattributed. When a thoracic disc or nerve root is genuinely the source, pain wraps around the chest wall in a band rather than travelling down a limb, and it can convincingly imitate cardiac or abdominal disease.

What is a Thoracic Epidural Injection?

A thoracic epidural steroid injection delivers corticosteroid and local anesthetic into the epidural space of the mid-back, under fluoroscopic guidance, to reduce inflammation around a compressed or irritated thoracic nerve root.

The thoracic epidural space is narrow and sits directly over the spinal cord, so this procedure demands meticulous image guidance and is performed only by physicians experienced with the anatomy.

Stage	What happens
Before	You're positioned, the skin is cleaned and numbed, and live imaging (fluoroscopy or ultrasound) guides the needle
During	The medication is placed precisely at the epidural space in your mid-back; most people feel pressure more than sharp pain
After	You rest briefly and go home the same day — arrange a driver if you received sedation

When It Is Used

Thoracic radiculopathy with band-like pain wrapping around the ribs
Thoracic disc herniation, which is uncommon but can be highly symptomatic
Post-herpetic neuralgia following shingles in a thoracic dermatome
Post-thoracotomy pain after chest surgery
Compression fracture pain in selected patients

What Makes It Different

Unlike the lumbar spine, the thoracic spinal cord occupies most of the canal, and unlike the cervical spine, the ribs constrain access. The interlaminar windows are small and angled steeply. These constraints mean the procedure is done under continuous fluoroscopy with contrast confirmation before any steroid is delivered.

Because thoracic pain is frequently referred from elsewhere, a careful workup precedes any injection. Cardiac, pulmonary, and abdominal causes must be excluded first.

Relief from Mid-Back and Chest Wall Pain at Remix Medical

Thoracic pain that has been dismissed, or attributed to muscle strain for months, deserves a proper evaluation.

How it's performed

With the patient prone under live fluoroscopy, the skin and deeper tissues are anesthetized. A needle is advanced into the thoracic epidural space using a carefully angled interlaminar or transforaminal approach appropriate to the narrow thoracic anatomy. Contrast confirms epidural spread and excludes vascular or intrathecal placement before corticosteroid and local anesthetic are injected.

How to prepare

Arrange a driver. Hold anticoagulants only as directed by the prescribing physician. Bring recent thoracic imaging and a current medication list. Cardiac and pulmonary causes of chest wall pain should be excluded before the procedure. Notify the office of any active infection or fever.

What to expect after

Ice the injection site 20 minutes every 2 to 3 hours for the first day. Avoid strenuous activity and heavy lifting for 24 to 48 hours. A temporary increase in pain for 1 to 2 days is common. Monitor blood glucose if diabetic. Report fever, severe headache, shortness of breath, or new weakness immediately.

Outcome

Appropriately selected patients typically experience reduced band-like chest wall or mid-back pain lasting weeks to months, often enough to allow progression with physical therapy and reduction of oral medication.

Frequently asked

Thoracic Epidural Injection questions, answered

What is a thoracic epidural steroid injection?

It's an anti-inflammatory injection into the epidural space of the mid-back to calm irritated nerves there. It's used for mid-back or wrap-around chest-wall nerve pain.

What does a thoracic epidural treat?

It helps mid-back pain from conditions like a herniated disc, nerve irritation, or shingles-related nerve pain. Your doctor confirms it's the right fit.

How long does relief last?

It varies from weeks to months and differs by person. It's frequently combined with physical therapy for more durable results.

What should I watch for afterward?

Mild soreness is normal; call for fever, severe pain, new weakness, or trouble breathing, which are uncommon but need prompt care.

Is the thoracic epidural injection safe?

Done with imaging guidance by an experienced physician, it's generally safe. As with any injection there are small risks, which your doctor reviews with you.

Sources

References

Manchikanti L, Knezevic NN, Knezevic E, et al. Epidural Interventions in the Management of Chronic Spinal Pain: ASIPP Comprehensive Evidence-Based Guidelines. Pain Physician 2021;24(S1):S27–S208 — https://www.painphysicianjournal.com/current/pdf?article=NzIwNg%3D%3D
Barreto MdM, et al. Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis: Systematic Review Summary — Report of the AAN Guidelines Subcommittee. Neurology 2025 — https://pubmed.ncbi.nlm.nih.gov/39938000/
Patel K, Chopra P, Upadhyayula S. Epidural Steroid Injections. StatPearls. NCBI Bookshelf — https://www.ncbi.nlm.nih.gov/books/NBK470189/
O'Connor RC, et al. Thoracic radiculopathy. Phys Med Rehabil Clin N Am — https://pubmed.ncbi.nlm.nih.gov/12122847/
Centers for Disease Control and Prevention: Shingles (Herpes Zoster) — https://www.cdc.gov/shingles/about/index.html
National Institute of Neurological Disorders and Stroke: Back Pain — https://www.ninds.nih.gov/health-information/disorders/back-pain

SpecialtyPain ManagementTypeProcedureBody locationThoracic spine, thoracic epidural space, thoracic nerve roots, intercostal nervesCPT code62320 (interlaminar, without imaging), 62321 (interlaminar, with imaging); 64479 (transforaminal, cervical/thoracic, single level), 64480 (each additional level)

Also called Thoracic ESI, Mid-Back Epidural Injection, Thoracic Epidural Steroid Injection

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated July 9, 2026. Medically reviewed by Raju Mantena, DO.