What is notalgia paresthetica?

Notalgia paresthetica is a nerve-related chronic condition that causes intense itching on your back, usually between the shoulder blades and the spine.¹ It is characterised by ‘nostalgia’, defined as pain and irritation, that stems from disruption in sensations of touch, known as dysaesthesia.¹ This includes feelings of numbness, tingling, burning or sensitivity.

Common symptoms of notalgia paresthetica include:

• Persistent itching - known as chronic pruritus, which is a constant itch that can occur over many weeks or years¹ 
• Visible skin changes - repeated scratching of the same area of skin over time leads to it changing colour in the irritated area, known as hyperpigmentation.² Temporary skin changes include redness, scratch marks and noticeable inflammation
• Unusual skin sensations - including tenderness, tingling, prickling, or feeling more hot or cold in the affected area¹

Living with notalgia paresthetica 

Whilst notalgia paresthetica is not usually harmful to health, it is often overlooked as a skin condition rather than a long-term neurological condition.³ It presents several overlapping symptoms, like persistent itching and hyperpigmentation, with other skin conditions, such as macular amyloidosis and tinea versicolor.¹ In fact, notalgia paresthetica accounts for 8% of all cases of chronic pruritus,¹ suggesting it is more common than we may realise.

Notalgia paresthetica can be an uncomfortable condition to live with, and the constant urge to scratch creates a repetitive cycle of itching, making it difficult to focus, sleep or go about daily activities. Finding ways to ease the symptoms and seeking treatment options is vital for living more comfortably and improving quality of life.

Why topical creams are a helpful option

Topical creams are a simple yet effective method of relieving the key symptom of notalgia paresthetica - persistent itching and inflammation. They are a targeted, straightforward, and non-invasive treatment method that immediately resolves discomfort in the affected area.¹ In many cases, creams can provide soothing relief on their own, but they are also used alongside other treatments such as medication or physical therapy based on how the condition presents and the underlying cause.

This article takes a closer look at the different topical creams available for managing notalgia paresthetica, including how capsaicin, lidocaine, and menthol creams can help relieve itching, burning skin and reduce discomfort.

Capsaicin cream

You may have heard of capsaicin in cooking, as the active ingredient in red chilli peppers that gives them their heat, but it also has a medicinal use. Capsaicin cream is the most common topical treatment option for notaliga paresthetica, which works to relieve the itch-related pain in muscles and joints directly at the site of discomfort.

How does it work?

Topical capsaicin cream works by making you feel desensitised to painful sensations that are sent from nerve cells in the affected area, responsible for sensations, to your brain.⁴ Specifically, it causes a chemical that is responsible for carrying the pain response to be released into the skin from nerve cells where it is held. This creates a stinging sensation which directly counteracts the burning feeling experienced at the affected site, providing immediate relief of pain.⁴

How is it used? 

Capsaicin cream can only be applied directly to the affected skin at the area of discomfort or pain. It is available as a cream, gel, lotion, or patch, and comes in different strengths varying from 0.025% to 0.1%.^1,5 Your doctor will advise you on the best strength based on your symptoms and the severity of pain experienced.

It is crucial to follow the instructions for safe and effective use, such as:

• Washing hands before and after application
• Avoiding contact with your eyes and mouth
• Keeping out of reach of children and storing correctly at room temperature
• Not applying the cream in more doses directed by your doctor
• Not applying to damaged or broken skin

Is it effective?

Capsaicin cream is effective in providing immediate pain relief, with some studies reporting a 70-90% improvement in painful itching in people affected by notalgia paresthetica after a few months of treatment.^5,6

However, the duration of the time during, the cream is effective varies across different cases of notalgia paresthetica, and continued use can reduce the effectiveness in providing itch relief over time.¹ In several cases, it has been reported that painful itching returns when the use of capsaicin cream stops, and that it may not be useful unless inflammation is present on the skin.^1,5 

Possible side effects

If you experience any side effects after applying capsaicin cream, stop using it and speak to your doctor or healthcare professional as soon as possible. These can include: 

• Stinging or burning - this is a commonly reported side effect and typically occurs when using a higher strength. It is important to monitor the severity of burning, as it often gets better as you keep applying the cream over time¹
• Allergic reaction - skin rash, swelling, persistent itching after application, hives. Seek medical attention immediately if you experience an allergic reaction to capsaicin cream
• Some mild reactions can include skin redness, dryness, or mild irritation.

Lidocaine cream

Lidocaine is a type of local anaesthetic, also known as a painkiller, is a widely used topical treatment option that helps relieve the intense itching pain experienced in notalgia paresthetica.

How does it work?

Once applied directly onto the skin, lidocaine cream causes localised numbness by stopping the nerves in the affected area from sending pain signals to the brain.⁷ This helps to alleviate the nerve-related itch and discomfort, which presents in notalgia paresthetica as it creates a temporary loss of sensation.

How is it used? 

Lidocaine cream can only be prescribed by a doctor or healthcare professional who will direct you on the correct usage and application based on your needs. As with capsaicin cream, lidocaine cream must be used safely and only directly on the skin, avoiding the mouth and eyes, and following the prescribed dosage. It is also available as a lotion, gel, spray, ointment, or can be administered via injection in severe, chronic cases of the condition.

Is it effective?

Topical lidocaine is widely known to be effective in directly tackling and reducing nerve-related pain and itch, and has been shown to completely resolve this symptom in some people experiencing notalgia paresthetica.⁵ But like capsaicin cream, it often presents the issue of symptoms returning after discontinuing use due to the temporary relief it provides.^5,7

Possible side effects

Lidocaine creams are usually safe and effective in treating localised itchiness and pain, but like any treatment option, they may present mild side effects or can be severe in some cases.⁸ It is important to speak to your doctor if you experience mild irritation or redness, as well as to seek medical help immediately if you feel unwell after applying lidocaine.

Side effects that you should watch out for include: 

• Allergic reactions - these can be mild, such as skin rash, redness, burning, swelling, persistent itching after application, and hives, or in rare cases, they can be more severe and may cause breathing problems⁸
• Cardiac arrest - local anaesthetics such as lidocaine can alter the electrical activity of the heart and cause arrhythmia, which is an irregular heartbeat, or in rare cases, can cause cardiac arrest⁸
• Seizures - particularly when high doses of lidocaine are given via injection⁹
• Nausea and vomiting
• Some mild, temporary reactions may include dizziness, headache, weakness, pins and needles, and vision changes or blurriness¹⁰

Menthol creams

Cooling topical creams containing menthol are generally used to help soothe irritated, dry and itchy skin across many itch-related skin conditions. It is also often recommended as a short-term treatment option for people living with a nerve-related itch, as seen in notalgia paresthetica.

How do they work?

Menthol creams work to counteract irritation and painful itch and make the skin feel cold by activating cold-sensing nerves that can make you feel less itchy.¹¹ Menthol can distract the brain from detecting feelings of itchiness by first stimulating nerves that carry pain signals but then gradually desensitising them.¹¹ Menthol creams also provide moisture to the skin, which can temporarily protect against dryness and irritation that can contribute to itchiness.¹²

How are they used? 

Topical menthol creams are widely available over the counter and at pharmacies, and there are many brand names and types with varying ingredients to suit specific needs. They are easily accessible without the need for a prescription, and can usually be applied to the skin as often as required to soothe itching and maintain the skin’s moisture barrier. It is important to avoid using menthol creams safely by avoiding broken or damaged skin as well as the mouth and eyes.

Are they effective?

Although menthol creams provide short-term relief from itchiness and skin dehydration, they are understood to be less effective on their own than capsaicin and lidocaine creams in treating notalgia paresthetica. They don’t contain any pain-killing properties, and they don’t directly address the nerve-related painful itch and the burning, tender sensations that occur due to notalgia paresthetica.¹¹ Rather, menthol creams can be used alongside capsaicin and lidocaine creams to better manage itchiness and discomfort overall.

Possible side effects

In most cases, menthol creams typically do not present side effects when they are used on the skin to relieve itchiness. But it is important to recognise if you experience any mild skin irritation or redness, as well as possible allergic reactions such as skin rash, swelling, or hives. Consult a doctor or pharmacist for advice or if you experience any discomfort or irritation upon applying menthol creams.

Which cream is right for you?

Finding the right topical treatment can be effective in helping to manage the symptoms of notalgia paresthetica - it could take some trial and error, but different creams may work better for different people based on the severity and frequency of pain, sensitivity, and discomfort. Guidance from a healthcare professional and exploring the topical creams available can help you keep the painful itch at bay.

Summary

Topical creams containing capsaicin, lidocaine and menthol are considered to be a first-line treatment in the management of notalgia paresthetica. These creams address itchiness and discomfort directly on the affected area of skin, making them effective exactly where they are applied and with regular, careful use. Trying different creams available can help you find which option works best, meaning you can feel more comfortable in your daily life.

If topical treatments don’t help, or you experience a severe, painful nerve-related itch or numbness that just does not subside, consult your doctor about other treatment options available for notalgia paresthetica, such as medication and physical therapy.