Introduction

Itching is an uncomfortable sensation in the body. Notalgia paresthetica is a chronic neurological condition where the patient complains of severe itching. Along with pruritus, patients also experience burning sensations, numbness, and discolouration on the mid-back, specifically just under the scapular region.¹ Even though it's not a dangerous disease condition, this has to be treated as it can cause extreme discomfort to the patient due to severe itching. Currently, various treatment options are available for Notalgia paresthetica. Oral treatments include anti-GABAergic, antihistamine, and anti-inflammatory drugs, while topical treatments involve the application of steroids and anaesthetics.² 

However, treating a pruritic condition with nerve involvement is a therapeutic challenge due to inadequate efficacy. Also, steroidal applications can’t be continued for a longer period. In recent years, there has been a growing interest in alternative therapies such as the use of herbal supplements, as it is natural and have fewer side effects compared to other treatments. Intake of supplements in a well-suited manner, along with dietary supplements as well as lifestyle modifications, can be beneficial in the treatment of Notalgia paresthetica. This article explores the potential of alternative therapies in managing NP.

Understanding the root cause of notalgia paresthetica

The exact cause of NP is not known. This is categorised under neurological disease, although the patient's presenting symptom turns out to be chronic itching and cutaneous lesions.³ The radiographic findings on patients suggest compression of the thoracic spinal nerve (T2 to T6) due to degenerative vertebral changes and herniated intervertebral discs. Recent studies reported that NP is associated with chronic inflammation and excessive oxidative stress⁴. Therefore, herbs with antioxidant and anti-inflammatory properties can do wonders in managing Notalgia paresthetica by addressing the underlying cause. Additionally, herbal topical applications can be beneficial in calming the skin and reducing skin irritations.

Herbal remedies

Topical herbal applications

Aloe vera

When it comes to skin, Aloe vera is a time-tested remedy blessed by nature for soothing, calming and deeply rejuvenating the skin. It contains an active ingredient called Glucomannan, which helps relieve skin irritation and itching. The gel extract also has Vitamin A, C, E and B12 alongside folic acid and choline, which act as antioxidants and neutralise free radicals formed from oxidative stress.⁵ And enzymes such as cellulase, lipase and bradykinase reduce the cutaneous lesion

Sandalwood oil

Sandalwood oil extracted from Santalum album, also called East Indian sandalwood, promises a cure in some of the dermatological conditions as it has antimicrobial, antibacterial and anti-inflammatory properties.⁶ Studies show that it eliminates the inflammation by altering various cytokines and chemokines. Sandalwood oil can be applied over the affected area to get relief from itching and skin irritation.

Neem

Neem is a traditional medicinal plant, and many scientific studies have validated its therapeutic efficacy. It contains antimicrobial, immunomodulatory and antioxidant properties, which show its efficacy towards skin ailments.⁷ A thin layer of Neem leaf can be applied to the affected area to reduce the skin irritation present in Notalgia paresthetica. 

Capsaicin (Chilli peppers)

Capsaicin is a natural derivative from chilli peppers and is found to give immediate relief in Skin hypersensitivity associated with NP. It causes a brief irritation in the initial phase and later desensitises the area after application.⁸ Capsaicin is available in the form of gel, creams and lotions.

Internal Herbal Remedies

Turmeric (Curcumin)

Turmeric and its primary compound curcumin have been widely investigated for their beneficial effects on inflammatory and oxidative stress. Excessive oxidative stress and nerve cell damage are considered the primary causes of NP. Additionally, a scientific study revealed that the curcumin compound has significantly reduced the hypersensitivity in neuropathic pain.⁹ Hence, it can give a favourable outcome in the management of NP.

Country mallow

Sida cordifolia, commonly known as country mallow, is a powerful neurotonic plant. The root of the country mallow plant is reported to be effective in treating most neurodegenerative disorders. The phytochemicals present in it work against inflammation.¹⁰ Therefore, the root extract can be used to reverse the pathology of NP.

Ashwagandha

Another widely popular and time-tested herbal supplement known for its antioxidant and anti-inflammatory properties. Regular use of Ashwagandha may help to regenerate spinal nerves.¹¹ Also, it is reported to be effective in treating skin inflammation. Thus, Ashwagandha can be considered as an ideal herbal supplement for the management of Notalgia paresthetica.

Dietary supplements

Dietary supplements also play a vital role in managing neurological disorders. These supplements may include: Vitamin B12, Magnesium, Omega-3 fatty acids, Alpha-Lipoic acids and Vitamin D. Among these micronutrients, Vitamin B12 helps in repairing the nerves.¹² Magnesium reduces muscle tension and thereby relieves nerve irritation. Omega-3 fatty acids have proven to mitigate nerve damage following a nerve injury; these are essential for maintaining nerve health, but the body cannot synthesise them.¹³ Therefore, dietary supplements are crucial to meet the body's demand. The natural sources are fish oil, Krill oil, flaxseed oil, walnuts, chia seeds and algae-based supplements. In addition to that, naturally occurring Alpha-Lipoic acid has been reported to have favourable outcomes in nerve damage caused by oxidative stress. Another crucial micronutrient to consider is Vitamin D. Nowadays, Vitamin D deficiency is prevalent worldwide, and its depletion is associated with nervous system disorders.¹⁴ So, for individuals with NP intake of the daily recommended dose of Vitamin D, it may support their overall health and symptom relief.

Lifestyle and supportive approaches

Along with herbal and dietary supplements, a regular practice of mild exercise and stretching, which involves the neck and shoulder muscles, is essential for relieving spinal compression. Studies have reported on the regression of symptoms in patients who have been practising regular home exercise and physiotherapy.¹⁵ Engaging in Yoga and meditation can be effective for postural correction and to reduce stress. Additionally, a balanced, nutritious diet and proper hydration are essential for improving the quality of life in patients with NP. 

Safety and considerations

Many researchers have shown the efficacy of these herbal supplements. However, further study is required to validate the safety of these herbs for long-term and optimal use. Additionally, some of them may interact with regular medications and cause adverse reactions. Therefore, it is essential to consult your healthcare provider before starting herbal supplements.

FAQ’s

1. Do these herbal supplements have a preventive role before the onset of Notalgia paresthetica?

Yes, Most of these herbal supplements are antioxidants, which prevent the body from oxidative stress and thereby prevent inflammation and cellular damage. Additionally, these herbs are well-known for their neuroprotective properties. Therefore, these supplements, when taken properly, can help NP and other neurological diseases. 

2. Are these herbal and dietary additives safe to use with regular medications?

Some supplements may react with certain medications. Additionally, the pharmacological interactions may reduce the absorption of drugs. So, it is important to talk with your healthcare provider before starting the herbal supplement.

3. How long does it take to experience a positive effect after taking herbal supplements? 

The result varies in every individual based on different factors such as the stage of the disease, health status and age of the patient. Some may notice a quick result within days, and others may need consistent use of these supplements for a longer duration.

Summary

Notalgia paresthetica is a rare condition predominantly in older females affecting the nervous system. Patients present with itching in the middle and lower area of the scapula, and the symptoms persist for months to years. Understanding the nature of the disease, a long-term administration of medications is not advisable as it may cause some adverse reactions in the patients. Therefore, an enhanced, comprehensive, holistic approach will be more beneficial for the patient. Previous studies on herbal supplements showed positive results in patients with Neurological disorders. Hence, herbal remedies along with dietary supplements and lifestyle modifications would be a better choice to alleviate symptoms in NP and thereby to optimise patient well-being.