What Is Notalgia Paresthetica?
The disorder's name is derived from the Greek word “notalgia,” which means back pain. Notalgia paresthetica is a rare neuropathic syndrome characterized by pruritus, accompanied by pain and itching at the particular site. The site and location of the disease are specifically termed as the infrascapular region, which is the area just below the shoulders; the pain is commonly experienced in the region of the back that is just beyond reach on the skin around T2-T6. It may present a hyperpigmented patch at the site. It is a chronic condition where a person can experience episodes of exacerbation and remission. Patients with notalgia paresthetica often have a history of neck, back, and shoulder pain, and arthritis, even if the findings are not noted radiographically. Studies have reported that notalgia paresthetica is associated with other musculoskeletal disorders, mainly in the C5 - C6 region. Individuals with notalgia paresthetica have reported having a compromised lifestyle due to repeated episodes of itching that cause discomfort.
What Causes Notalgia Paresthetica?
The disease's definite etiology is unknown but is considered to be caused due to nerve impingement either by the muscle or the bone. Some researchers suggest that notalgia paresthetica may be caused by a defect in the nerve cells that supply the skin in the area. Another school of thought suggests that notalgia paresthetica results from underlying musculoskeletal disorders that include degenerative muscular spine disease or muscular spasm.
Notalgia paresthetica or neuropathy is mainly caused due to:
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Trauma to the back.
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Diabetic neuropathy.
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Disorders of the spine.
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Herniated disc.
How Does a Patient Present?
Patients with notalgia paresthetica generally present with a history that is suggestive of local neuropathy. Some common complaints that the patient reports are as follows::
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Spider bite sensation.
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Prickly feeling.
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Allergy to the bra strap, tight clothing over a particular site.
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Mild burning sensation over the site.
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Surface numbness.
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Notalgia paresthetica is rare but seen in individuals with multiple endocrine neoplasia 2A.
Subjects, when examined clinically present with an ill-defined pink non-indurated skin patch 3-10 mm in size at the mid-back region. The neck, on examination, reveals tenderness, compromised function, and muscular spasm in the affected area.
How Is Notalgia Paresthetica Diagnosed?
A diagnosis, like every other disease, mainly depends on detailed patient history and keen clinical examination. A supportive diagnostic tool like expand, X-ray, CT expandscan, and biopsy can also be ordered to confirm the diagnosis and rule out other similar medical conditions.
The steps in the diagnosis are as follows:
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Detailed case history.
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Careful clinical examination.
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Biopsy of the affected site.
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Radiographic examinations (in patients with a history of trauma).
Which Diseases Have a Similar Presentation?
Notalgia paresthetica can be easily confused with skin disorders as they present a similar lesion. Some of such diseases are listed below:
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Allergic contact dermatitis.
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Arthropod bite reaction.
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Atopic dermatitis.
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Herpes zoster.
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Impetigo.
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Post-inflammatory hyperpigmentation.
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Tinea corporis.
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Drug eruptions.
Diagnostic tests like biopsy are used to differentiate and rule out the diseases to confirm the diagnosis.
What Are the Complications of Notalgia Paresthetica?
If the disease persists and is ignored for a longer duration can lead to complications, especially when the lesions are present, which tend to get infected.
An infected site of notalgia paresthetica might result in the following conditions:
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Skin excoriations.
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Secondary skin infection.
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Prurigo nodules.
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Lichen amyloid.
Symptoms of notalgia paresthetica are confused with some malignancies but never are known to transform into malignancy.
Therefore it is important to seek medical help at the right time if the symptoms:
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Do not get better in a few days.
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Are intense.
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Started after trauma.
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It is accompanied by symptoms like numbness, tingling, and pain.
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Spread to other parts.
How Is Notalgia Paresthetica Treated?
The treatment modalities for notalgia paresthetica mainly aim at treating the underlying disorder like spinal disease and relieving the pain and discomfort caused by the neuropathy.
Non-invasive treatment options include:
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Physiotherapy.
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Massage therapy.
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Spinal manipulation.
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Acupuncture.
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Cervical collars.
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Cervical strengthening.
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Cervical traction.
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Transcutaneous electric nerve stimulation.
The above-mentioned treatments help in relief and are used as the first line of treatment.
Medicinal treatment includes using non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, etc.
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Gabapentin- Gabapentin is an anti-seizure drug used to treat notalgia paresthetica; it is prescribed to reduce itching and recommended to be taken once a day.
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Capsaicin- A medication that is dispensed as a cream or patch is used to treat the itching in notalgia paresthetica. It is recommended to be used five times a day for a week and three times a day for the next 3-4 weeks. The use of capsaicin can cause a burning sensation.
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Local Pain Relievers- Lidocaine and Prilocaine can also be used for temporary relief, which is used as local applications.
Long-term relief might require more intense and invasive treatment modalities like nerve blocks and Botox injections.
Home remedies like the application of creams containing camphor exercises like a back stretch with folded arms and back relaxations can help improve the itching.
Conclusion:
Notalgia paresthetica is a neuropathic condition that causes itching in the back at the infrascapular region, which can be caused by nerve impingement due to underlying causes like spinal injury or muscle spasm. Clinically, patients present with a red, irregular patch beyond the area of reach. Itching at the site causes discomfort and affects the life of an individual. Notalgia paresthetica can be treated at home to relieve the symptoms using camphor creams, or regular exercises can help muscle relaxation. Medicinal treatments include the use of NSAIDs and muscle relaxants, physical therapy, massages, and other therapies also help improve the condition; long-term treatments are carried out using Botox injections or nerve compression therapies.