Abstract
Notalgia paresthetica, a neurosensory syndrome that typically occurs on the upper back, has multiple clinical symptoms with variable degrees of expression in each individual afflicted with the condition. The involved site is usually hyperpigmented and is associated with burning, coldness, hypoesthesia, increased pain, pruritus and/or tingling. In the affected area, the number of nerve fibers may be increased and the cutaneous sensory nerves are altered secondary to localized impingement, central injury, or both. Although multiple therapeutic approaches for notalgia paresthetica have been described, none specifically address the essential pathogenesis of the condition—the altered cutaneous nerves. Cryolipolysis is a well-tolerated nonsurgical technique to reduce the subcutaneous fat layer. Selective apoptosis of adipocytes occurs since the lipid-rich fat cells are more susceptible to cold injury than the surrounding water-rich cells. Not only a marked decrease in pain sensitivity but also a sustained reduction in the density of myelinated and unmyelinated cutaneous nerves has been observed in cryolipolysis-treated skin. Therefore, cryolipolysis is a logical approach to the treatment of notalgia paresthetica. One or more cryolipolysis treatments may be necessary for complete or partial resolution of the individual’s notalgia paresthetica-related cutaneous symptoms. In conclusion, evaluation of cryolipolysis as a noninvasive treatment of patients with notalgia paresthetica is warranted.
Highlights
BackgroundNotalgia paresthetica is a neurosensory condition that typically occurs on the upper back
Latissimus dorsi and rhomboid muscle strengthening Pectoral muscle stretching Massage Multimodal physiotherapy Narrow band ultraviolet-B Osteopathic manipulative treatment Inhibition and soft tissue techniques Rib raising Scapulothoracic fascial release Suboccipital decompression Surgery Transcutaneous electrical muscle stimulation (EMS) Transcutaneous electrical nerve stimulation (TENS) Oral Antidepressants Selective serotonin norepinephrine reuptake inhibitors Tricyclic antidepressants Antihistamines (sedative H1 and/or non-sedative H1) Gabapentin Muscle relaxants Nonsteroidal anti-inflammatory drugs Oxcarbazepione Pregablin Peri-neural Paravertebral nerve block Topical Anesthetics Capsaicin (0.025% and 0.075%) cream Corticosteroids
In contrast to the earlier study by Coleman, et al [41], the investigators found that there was a prolonged reduction in the density of both myelinated and unmyelinated cutaneous nerves following cryolipolysis; the former group of nerves in the dermis was most greatly affected [7]
Summary
Notalgia paresthetica is a neurosensory condition that typically occurs on the upper back. There is an alteration of the cutaneous sensory nerves resulting from either localized impingement, central damage and irritation, or both; in addition, an increased number of nerve fibers may be present [1,2,3,4]. A sustained decrease of myelinated and nonmyelinated sensory cutaneous nerves, along with decreased vibratory and thermal pain, has been demonstrated in skin following cryolipolysis [5,6,7]. How to cite this article Cohen P R (September 28, 2017) Notalgia Paresthetica: A Novel Approach to Treatment with Cryolipolysis. Cryolipolysis—which results in decreasing cutaneous sensory nerves, may be a novel modality for the successful management of notalgia paresthetica
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