title: A systematic evaluation of thoracic interlaminar epidural injections.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The limitations of this study include paucity of evidence.
  
  
  CONCLUSIONS
  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.
authors: Millennium Pain Center, Bloomington, IL, USA. ramsinbenyamin@yahoo.com
authors: Ramsin M
authors: RM
authors: Benyamin
authors: Victor C
authors: VC
authors: Wang
authors: Ricardo
authors: R
authors: Vallejo
authors: Vijay
authors: V
authors: Singh
authors: Standiford
authors: S
authors: Helm Ii
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001416:Back Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D013904:Thoracic Vertebrae
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local