Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica

Abstract

BACKGROUND notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits. OBJECTIVES To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica. METHODS We conducted an experimental, non-randomized, parallel, non-blinded study including 20 patients with clinical and histopathological diagnosis of notalgia paresthetica. After application of the visual analogue scale of pain adapted for pruritus and of the questionnaire of dermatology life quality index (DLQI), ten patients with visual analogue scale > 5 were given treatment with gabapentin at the dose of 300 mg/day for four weeks. The other ten were treated with topical capsaicin 0.025% daily for four weeks. After the treatment period, patients answered again the scale of itching. RESULTS The use of gabapentin was responsible for a significant improvement in pruritus (p=0.0020). Besides itching and hyperchromic stain on the back, patients reported paresthesia and back pain. It was observed that the main factor in the worsening of the rash is heat. CONCLUSION Gabapentin is a good option for the treatment of severe itching caused by nostalgia paresthetica.

Notalgia Paresthetica Relieved by Cervical Traction

“…1 Case reports have shown variable improvement of itch with topical capsaicin 6 , lidocaine, and prilocaine topical cream (Emla cream) 7 , tacrolimus ointment 8 , cutaneous botulinum toxin type A injection 9 , local paravertebral nerve block 10 , transcutaneous electric nerve stimulation 11,12 , surgical nerve decompression 13 , epidural steroid injections, and UVB light treatments 14 ; and with the drugs gabapentin 15 , oxycarbazepine 7 , amitriptyline 16 , and phenytoin. 1 However, these treatments are typically temporary, invasive, or expensive, or have potential side effects.…”

A woman with an itchy hyperpigmentation on her back

“…Consider antihistamines, menthol ointment, topical corticosteroids, topical capsaicin,4 gabapentin,5 physiotherapy, and physical exercise for the pain and pruritus 2. In some cases the condition persists for more than 20 years 12…”

Practice Gaps in Pruritus

“…Gabapentin has been found to be effective in uremic pruritus, [13][14][15] burns, 16 notalgia paresthestica, 17 neuropathic itch, 14 and itch occurring in palliative patients. 13,18 Additional agents that should be considered for the treatment of itch include pregabalin, mirtazapine, butorphenone, naltrexone, aprepitant, and narrow-band ultraviolet B.…”