Notalgia Paresthetica

Notalgia Paresthetica: Symptoms | Causes | Treatment

Notalgia Paresthetica

What is notalgia paresthetica?

Notalgia paresthetica (NP) is a nerve disorder that causes intense and sometimes painful itching in your back. It mainly affects the area between the shoulder blades, but the itch can spread to your shoulders and chest.

The name of this disorder comes from the Greek words “notos” (“back”) and “algia” (“pain”).

What are the symptoms?

NP causes an itch just below your left shoulder blade. The itching can range from mild to so severe that it makes you want to rub your back against a post or wall. Scratching might feel good, but it won’t always relieve the itch.

Some people feel the itching on the right side or both sides of their back, under their shoulder blade. The itch can spread to your shoulders and chest.

Along with itching, NP can sometimes cause these symptoms in the upper back:

  • pain
  • tingling, numbness, and burning sensations
  • pins-and-needles feeling
  • increased sensitivity to heat, cold, touch, vibrations, and pain

Scratching the itch can cause patches of darker-colored skin to appear in the affected area.

What causes notalgia paresthetica?

Doctors don’t know exactly what causes NP. They think it starts when bones or muscles trap and put pressure on nerves in the upper back.

Possible causes include:

  • back injury
  • herniated disk
  • spinal cord disease (myelopathy)
  • shingles

Pressure on the nerves restricts blood flow, makes the nerves swell up, and leads to nerve damage. Swelling and damage cause the nerves to overreact and send messages to your brain that you’re itching or in pain when you aren’t.

Less often, NP affects people with multiple endocrine neoplasia type 2 (MEN2). This inherited condition causes tumors to form, and they can put pressure on nerves. Usually NP only affects adults, but with MEN2, children can have it as well.

How is notalgia paresthetica diagnosed?

Itching is a very general symptom that can be caused by many different conditions. Your doctor will rule out other common causes of itching, like contact dermatitis or psoriasis, when making a diagnosis.

The doctor will ask about your symptoms and look at your back. They might remove a small sample of skin in the itchy area for testing. This is called a biopsy. It can help rule out other itchy skin conditions like a fungal infection or lichen sclerosus.

If your doctor suspects that an injury caused your symptoms, you might have one of these imaging scans to look for damage to bones or other structures in your back:

  • X-ray
  • computed tomography (CT) scan
  • magnetic resonance imaging (MRI)

What are the treatment options?

Medications can bring down swelling and help relieve the itch temporarily. Doctors use the following to treat NP:

  • High-dose capsaicin cream. This helps desensitize the nerve endings that make you feel itchy. You use it five times a day for one week and then three times a day for three to six weeks. Capsaicin also comes in patch form.
  • Local pain relievers. Lidocaine 2.5 percent and prilocaine 2.5 percent cream twice a day may help reduce symptoms.
  • Corticosteroid creams and injections. These may also help with the itch.

Any relief you get from these treatments is likely to be short-lived. Symptoms tend to come back within a few days to weeks after stopping the medication. Capsaicin can cause side effects such as burning, tingling, and pain.

Some doctors treat NP with the antiseizure drug gabapentin (Neurontin). This seems to reduce the itch in people with severe cases. Other drugs may also help with NP symptoms, such as:

  • epilepsy drugs carbamazepine (Tegretol) and oxcarbazepine (Trileptal)
  • tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants

Nerve blocks and botulinum toxin type A (Botox) injections might offer longer-lasting relief from itching. The trouble is, these treatments haven’t been evaluated in large groups of people.

However, in one study, a woman who was treated with a nerve block injection stayed symptom-free for a year. Another report showed that relief from botulinum toxin lasted 18 months.

Even though this injection tends to wear off within six months, it may affect nerve signaling in a way that leads to more long-term symptom control.

Other treatments that doctors try for NP include:

  • transcutaneous electrical nerve stimulation (TENS), which uses a low-voltage electrical current to relieve pain
  • acupuncture
  • ultraviolet B (UVB) light therapy
  • osteopathic manipulation

How can you get relief at home?

To get relief from the itch and pain of NP at home, apply a cooling cream to your back. Look for a product that contains ingredients like camphor or menthol.

Stretching can help lighten the pressure on your nerves and relieve your symptoms. Here are a few exercises to try:

  • Stand with your arms at your sides. Lift just your shoulders and rotate them forward. Then reverse the movement, rotating your shoulders backward.
  • Hold your arms straight at your sides and rotate them forward all the way around until they’re back resting at your sides. Repeat, rotating your arms backward.
  • Stand with your elbows out, arms bent at a 90-degree angle. Squeeze your elbows back toward one another until you feel a stretch in your back.
  • Stand with your arms behind your back. Clasp your hands together. Press down until you feel a stretch in your back.
  • While sitting, cross your arms and bend forward to stretch your back.

Could this be a sign of cancer?

NP isn’t cancer. Although skin changes can sometimes be a symptom of cancer, itchy skin is rarely a sign.

Melanoma skin cancer may itch, but it looks like a mole and can be on any part of your body — not necessarily on your back.

A blood cancer called polycythemia vera causes itchiness after a warm shower or bath, but the itching is just one of its many symptoms. Other signs include dizziness, headache, fatigue, and trouble breathing.

Rarely an itchy skin rash can be a sign of leukemia or lymphoma.

What’s the outlook?

Itching in your upper back could be caused by any number of things, from skin irritation to a fungal infection. You may be able to treat it yourself at home.

Call your doctor if the itching:

  • doesn’t go away after a few days
  • is intense
  • happens with other symptoms, such as numbness, tingling, or pain in the area
  • spreads to other parts of your back

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