An epidural injection can target the painful area. The injection bathes the nerves and intervertebral discs in local anaesthetic and steroid solution. Only a small amount of steroid is needed and it will not cause any of the side effects sometimes associated with taking steroid tablets. They are not the same kind of steroids that athletes may take. This steroid injection relieves pain and inflammation. Pain, caused by inflamed nerves felt in the chest wall, can be treated in this way. Bathing the inflamed discs in this way may also reduce some upper back pain.
What has gone wrong?
You have suffered general wear and tear or damage from injury to the intervertebral discs in your spine. When the disc is inflamed, the nearby nerves become irritated. These nerves supply sensation to the chest wall and hence the brain is fooled into believing that the chest wall is injured. This is not the case; although you may feel pain in the chest the problem is in the spine.
The aim of the procedure is to reduce the inflammation of the disc. This reduces your chest wall pain and some of your back pain.
Your pain should be reduced and you should be able to move around more easily. You can then exercise to prevent the problem happening again. If successful, this treatment can avoid the need for surgery.
Are there any alternatives?
By the time you consider a thoracic epidural you should have already tried other more simple treatments. These include rest, painkilling and anti-inflammatory tablets, and physiotherapy with exercise.
You may also have tried a transcutaneous electrical nerve stimulation (TENS) machine for your pain. This works by sending soothing pulses across the surface of the skin and along the nerve fibres. These pulses prevent pain signals reaching the brain. They also stimulate your body to produce higher levels of its own natural painkillers, called endorphins.
What if you do nothing?
If you do nothing there are several things that may happen:
With time and rest the inflammation and pain may settle on its own
The pain and difficulty in moving around may remain the same
The pain may increase
The disc may become further damaged and may injure the nerves that control movement. You may then develop weakness and difficulty in moving your legs. Some of this may be permanent
In rare and severe cases you may lose control of your bladder and bowels as the nerves that control these are damaged
Who should have it done?
The following groups of patients should have the procedure done:
Who should not have it done?
Each patient has the final decision as to whether to proceed or not. If you are unhappy about the procedure for any reason you should not continue.
There are specific medical situations when an epidural should not be done and they are as follows:
When a patient is on medication that prevents blood from clotting, such as warfarin. This would lead to more bleeding than normal. It may be possible to stop the medication a few days before the procedure. This will need to be discussed with your doctor
When a patient is suffering from an illness that prevents blood from clotting, such as haemophilia. This would also lead to more bleeding than normal
When there is infection of the skin over the site where the needle needs to be put in
When the patient has a bloodstream infection
When a patient has noticed a recent worsening of their symptoms, especially weakness and loss of bladder or bowel control
Author: Dr Sean White FRCA. Consultant in pain and anaesthesia.
© Dumas Ltd 2006