Notalgia Paresthetica Review: Update on Presentation, Pathophysiology, and Treatment

Abstract

Purpose of Review: Notalgia paresthetica (NP) is a chronic cutaneous neuropathy primarily characterized by localized pruritus and associated dysesthesias, including sensations of pain, numbness, and tingling. The sensory neuropathy characteristic of NP is thought to result from spinal nerve entrapment caused by degenerative changes in the spine or musculoskeletal compression. This review summarizes the current medical literature with a focus on the past five years regarding NP, its pathophysiology, presentation, and current treatment options. Recent Findings: Though treatments exist with varying efficacy, to date, there exists no definitive treatment for NP. Treatment options for NP are varied and range from topical and oral agents to interventional procedures and physical therapy. Of the treatments evaluated, topical capsaicin remains the most efficacious treatment for NP. Conclusions: The lack of established treatment guidelines makes treating NP complicated as it dramatically affects patients’ quality of life. Further research with larger sample sizes is needed to evaluate better the most effective treatment and dosing regimen for patients afflicted with NP.

A systematic review of procedural modalities in the treatment of notalgia paresthetica

“…Hence, it is imperative to correctly recognize and treat NP, particularly as it is reported to be underdiagnosed in several cases 27 . The exact etiology of NP is still uncertain; however, it is suggested that a multifactorial process involving muscle impingement, increase in dermal innervation, and any spinal pathology may contribute to the progression of this condition by affecting the posterior cutaneous branches of T2–T6 spinal nerves 28 . Following chronic rubbing and scratching to relieve the discomfort, hyperpigmented patches and lichenification appear on the affected part of the back.…”

“… 27 The exact etiology of NP is still uncertain; however, it is suggested that a multifactorial process involving muscle impingement, increase in dermal innervation, and any spinal pathology may contribute to the progression of this condition by affecting the posterior cutaneous branches of T2–T6 spinal nerves. 28 Following chronic rubbing and scratching to relieve the discomfort, hyperpigmented patches and lichenification appear on the affected part of the back. Considering dermatological or neuromuscular aspects of NP, clinicians consider various therapeutic strategies to alleviate clinical signs and symptoms with different levels of success.…”

Evaluation of fibromyalgia frequency and quality of life in Notalgia paresthetica patients

“…In our study, we had a patient who underwent almost all treatment modalities. NP, like many treatment-resistant cases, is a disease without mortality but can adversely affect patients' quality of life [ 21 ].…”

Notalgia Paresthetica Responding Positively to Chiropractic Spinal Manipulation: A Case Report

“…Notalgia paresthetica (NP) is a chronic cutaneous neuropathy characterized by localized pruritus and associated pain, numbness, and/or paresthesia, affecting the medial or inferior scapular border [1]. It is classified as a type of neuropathic itch, which is an itch caused by a lesion of or disease of the somatosensory nervous system [2].…”

“…It is classified as a type of neuropathic itch, which is an itch caused by a lesion of or disease of the somatosensory nervous system [2]. NP is often associated with degenerative changes in the cervical and/or thoracic spinal joints, yet definitive mechanisms leading to pruritus have not been elucidated [1,3]. In addition, treatment for NP remains underexplored [1].…”