What is Notalgia Paresthetica?

Notalgia Paresthetica is a distinctive and often misunderstood dermatological condition that results in intense itching, tingling, or burning sensations between the shoulder blade and spine. Although not considered detrimental to overall health, its discomfort can substantially impact a person's quality of life. 

This article will explore various aspects of Notalgia Paresthetica, including its causes, symptoms, diagnosis, and available treatment options.

An overview of notalgia paresthetica

Notalgia Paresthetica (NP) is a sensory neuropathic syndrome.¹ The condition is a part of a family of skin conditions called chronic pruritis. 

The term "notalgia" is derived from the Latin words "notum" (back) and "algia" (pain), highlighting the condition's primary symptom – persistent itching or discomfort on the skin of the back.

These itching, tingling, and burning sensations are typically localized and felt in a single area. However, they can spread to the shoulders and chest in some cases. According to a study, NP is relatively common but often left undiagnosed and untreated.² The condition can last anywhere from months to years and worsen from time to time.

Causes of notalgia paresthetica

While the exact cause of Notalgia Paresthetica (NP) remains unclear, experts believe pressure on the nerves may be a contributing factor. The pressure restricts blood flow, making the nerves swell up, which leads to nerve damage.

This irritation or damage causes the nerves to overreact and encourages them to send incorrect messages to the brain, making it believe you are itching or in pain when you are not. 

The factors contributing to NP are outlined below:

Nerve impairment

A major factor in the development of NP is thought to be compression or irritation of nerves in the upper back, especially the posterior cutaneous nerve of the thorax. This nerve carries sensation from the skin of the upper back.³

Neurological dysfunction

Dysfunction in the nerves that transmit sensory signals from the skin to the brain can lead to abnormal sensations, such as itching or burning, a common characteristic symptom of NP.

Spinal abnormalities

NP may be triggered by spinal conditions, such as degenerative changes, disc problems, or bony osteophytes (overgrowth of vertebrae), that can result in nerve compression.^4,5

Symptoms and triggers of notalgia paresthetica

Recognizing the symptoms and triggers of Notalgia Paresthetica (NP) is crucial for an accurate diagnosis, treatment, and long-term management of the condition. 

Some of them are listed below: 

 Common symptoms

• Persistent itching: the hallmark symptom of NP is an unrelenting itch in a localized area on the upper back, often between the shoulder blades
• Burning sensation: individuals can sometimes experience a burning or tingling sensation in addition to the initial itching
• Skin changes: continuously scratching the itch may result in skin changes such as redness, inflammation, or small pimples
• Hyperpigmentation: because of the chronic irritation and scratching of the affected skin, it might get darker over time

Common triggers

• Prolonged sitting or immobility: sitting in the same position for extended periods and poor sitting posture can trigger NP flare-ups. This immobility, combined with general sedentary behaviour, will increase pressure on the upper back nerves and thereby make symptoms worse
• Clothing-related triggers: tight or restrictive clothing that rubs against the affected area may irritate the skin and worsen itching. Choosing loose-fitting clothing can minimize friction on the upper back and provide relief
• Environmental factors: temperature changes and humidity can cause changes in the severity of the symptoms. Excessive heat or humidity can aggravate itching, and some people report extra discomfort during warmer weather

Diagnosing notalgia paresthetica

Diagnosing Notalgia Paresthetica (NP) can be challenging because there aren’t any specific laboratory tests or imaging studies to confirm the condition. However, this doesn't mean that the condition is undetectable. 

Healthcare professionals use a combination of physical examination, medical history and exclusion of other potential causes to make a diagnosis. Key steps in the diagnosis include:

• Medical history: A detailed dialogue with the patient about the nature of the start of the symptoms, their characteristic, the length of time they have been experienced, and any changes in them is very important for discovering information that helps establish a diagnosis
• Physical examination: a complete physical examination, involving observation and palpation of the affected area, can help to rule out other skin or musculoskeletal conditions
• Skin biopsy: this may sometimes be performed, in case there are still doubts about the diagnosis, to rule out other skin disorders⁴

Notalgia paresthetica treatment options

Managing NP concentrates on symptom relief and improving overall quality of life. 

Treatment choices might include:

• Topical creams: topical ointments, obtained via prescription or over-the-counter, and often containing menthol, capsaicin, or corticosteroids may help keep the sensation of itching under control and improve comfort^6,7
• Physical therapy: specific exercises and stretches targeting the upper back can help alleviate nerve compression and improve symptoms
• Nerve blocks: in some cases, nerve blocks with local anaesthetics may be considered to provide temporary relief from symptoms⁸
• Oral medications: medications such as antihistamines, difelikefalin, and gabapentin may be prescribed to help with itching and neuropathic pain symptoms^9,10

Living with notalgia paresthetica

People with NP can adopt certain lifestyle modifications, which can help you to minimize symptoms and prevent them from worsening. 

Examples include

• Avoid scratching: not engaging in excessive scratching may be incredibly difficult but breaking the ‘vicious circle of itch and scratch’ can produce benefits because this prevents further skin damage, and so avoids making symptoms worse
• Cool compresses: applying a cold compress to the affected regions can soothe itching and lower inflammation
• Wear loose clothes: opting for loose-fitting clothing can minimize friction between the fabric and skin and thus irritation of the skin
• Posture awareness: maintaining good posture can improve spinal health and avoid the nerve compression contributing to NP
• Support groups: online forums and groups dedicated to supporting people with NP may be helpful. Other people with NP can be capable of real empathy, giving emotional support and insights that might be relatable. In some cases, these groups might also point you to appropriate counselling or therapy sessions, which might help with the psychological aspects of living with this NP
• Mind-body techniques: using techniques such as meditation, deep breathing protocols, and mindfulness might help with your stress management, and so reduce the effects of NP on your quality of life¹¹

Summary

Notalgia Paresthetica may be a less well-known skin condition, but its impact on those affected should not be underestimated or dismissed. 

By understanding its causes, symptoms, diagnosis, and available treatment choices, those affected and doctors can work together to manage the condition thereby improving the sufferer’s quality of life. 

Ongoing research might reveal new insights that lead to new, effective treatments.