A Case Report of Refractory Notalgia Paresthetica Treated with Lidocaine Infusions

Abstract

Patient: Female, 50Final Diagnosis: Notalgia paretheticaSymptoms: Hyperalgesia • PruritusMedication: —Clinical Procedure: Intravenous lidocaine infusionSpecialty: AnesthesiologyObjective:Unusual or unexpected effect of treatmentBackground:Notalgia paresthetica is a neuropathic condition that manifests as a chronic itch in the thoraco-dorsal region. It is often resistant to treatment, and specific guidelines for its management are lacking. As such, we present a treatment approach with intravenous lidocaine infusions.Case Report:The case involves a 50-year-old woman with spinal cord injury caused by an epidural abscess. The patient developed notalgia paresthetica and sublesional neuropathic pain following its drainage. In the course of her pain management, she was treated with intravenous lidocaine which resulted in profound relief of notalgia paresthetica.Conclusions:Intravenous lidocaine was effective in relieving neuropathic itch in the patient case presented.

Notalgia paresthetica: clinical features, radiological evaluation, and a novel therapeutic option

“…Three infusions of lidocaine at two-week intervals at a dose of 1 mg/kg bolus followed by 4 mg/kg infusion over 1 h were administered. Following the first two infusions, neuropathic pain was not relieved; however, significant relief of pruritus was observed [2]. We also previously reported a 73-year-old male case with NP treated with therapeutic lidocaine injections.…”

“…However, significant relief of itching was noted. They concluded that intravenous lidocaine was effective in reducing neuropathic itching [2].…”

“…NP can exacerbate from time to time and lasts for months to years. It is widely accepted that NP is a sensory neuropathy which occurs as a result of the alteration of the cutaneous branches of the posterior rami, especially the upper branches of the T2-T6 spinal nerves [2,3].…”

“…The treatment of NP is multidisciplinary, including topical agents (intralesional steroids, botulinum toxin A, capsaicin, and lidocaine), systemic drug treatments (gabapentin, oxcarbazepine, and amitriptyline) and physical therapy methods (TENS, cervical traction, exercise, and manipulation) [2,3,10]. In the literature, there are studies describing lidocaine treatments for NP.…”

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“…19 Other therapies documented include TENS, 20 EMS, 21 Narrow band UV-B, 22 osteopathic manipulation, 23 acupuncture, 24 exercise 25 and physiotherapy. 3 Paravertebral nerve blocks, 26 intravenous lidocaine infusions 27 and surgical decompression 28 have also been described. ESI and occipital nerve block have not yet been described as viable treatments for NP.…”