Notalgia Research Articles

Report on 25 Notalgia paresthetica cases: Clinical features and treatments.

Notalgia paresthetica (NP) is a neuropathic condition that manifests as a chronic itch on the back. The aim of this retrospective study was to examine the characteristics of patients diagnosed with NP. A total of 25 female patients, aged 26-64 years (mean+-10.67 years; median 47.17 years), were studied to determine the spinal or peripheral origin of NP. On radiological examination, discopathy was observed in 24% of the patients, arthrosis in 32%, and degeneration in 56%. There was no significant relationship found between dermatological symptoms and magnetic resonance imaging posi-tivity (p=0.188). The patients' treatment programs were based on either physical therapy (44%), local injection (28%), exercise therapy (16%), or physical therapy and kinesiotherapy (12%). Subjective measures for pain were validated with an average visual analog scale (VAS), and the 'Douleur Neuropathique 4' (DN4) questionnaire was used to screen for neuropathic pain. The VAS score of the patients before treatment was 7, and after treatment was 2. The mean DN4 score was 7 before treatment and 2 after treatment. NP is a rare syndrome of unknown etiology. We aim in this study to analyse NP clinical properties and treatment.

Treatment of a Patient Diagnosed with Notalgia Paresthetica by Dry Needling: A Case Report

Treatment of a Patient Diagnosed with Notalgia Paresthetica by Dry Needling: A Case Report

An osteopathic approach to Notalgia Paresthetica: case report, review of the literature, and proposal of an autonomic-neurologic-lymphatic model of notalgia paresthetica

An osteopathic approach to Notalgia Paresthetica: case report, review of the literature, and proposal of an autonomic-neurologic-lymphatic model of notalgia paresthetica

Difelikefalin: First Approval.

Difelikefalin (Korsuva™) is a synthetic peptide agonist of the kappa opioid receptor being developed by Cara Therapeutics for the treatment of pruritus. In August 2021, intravenous difelikefalin was approved in the USA for the treatment of moderate-to-severe pruritus associated with chronic kidney disease (CKD) in adults undergoing haemodialysis. Intravenous difelikefalin has also been evaluated for CKD-associated pruritus in patients undergoing haemodialysis in various other countries, with Marketing Authorization Application under regulatory review in the EU and a phase III trial ongoing in Japan. Clinical studies of an oral formulation of difelikefalin have also been completed or are underway in pruritus indications, including pruritus associated with atopic dermatitis, notalgia paraesthetica or primary biliary cholangitis. This article summarizes the milestones in the development of difelikefalin leading to this first approval for CKD-associated pruritus in adults undergoing haemodialysis.

Treatment of notalgia paresthetica with low dose pregabalin: Retrospective evaluation of 13 patients

Background: Notalgia paresthetica (NP) is a sensory neuropathic syndrome characterized by chronic itching of the unilateral mid-back. Topical and systemic symptomatic treatments have been used to date. In recent years, neuropathic pain medicine has been used to relieve the symptoms of the disease. The aim of this study was to determine the effectiveness of pregabalin in notalgia paresthetica. Materials and Methods: In this study, the files of the patients with a diagnosis of NP and treated with pregabalin for at least one month in the period between 2016 and 2018 were evaluated retrospectively. Results: Thirteen cases of NP treated with low-dose (up to 150 mg/day) pregabalin were evaluated, and 9 (70%) patients exhibited a good response in this retrospective study. All patients were female and the mean age was 53.5 (31–71) ± 10.3 years. The mean disease duration was 6.1 (1–10) ± 4.1 years. Conclusion: Treatment with low-dose pregabalin may be a good option for the symptomatic treatment of NP.

Notalgia paresthetica: An underdiagnosed condition in primary care.

Notalgia paresthetica is a perplexing diagnosis in the primary care setting. Chronic itching, paresthesia, or pain causes discomfort in patients who suffer with notalgia paresthetica and it is thought to be a common but underdiagnosed condition. Recognition of this dermatologic condition can lead to reassurance and relief for affected patients.

26622 The impact of neuropathic itch on patients’ quality of life

The negative impact of chronic itch on patients’ quality of life (QoL) has been well established in literature, with similar burden of disease and effects on self-esteem as the more well-studied chronic pain. However, most studies to date have focused on chronic inflammatory pruritic conditions, like atopic dermatitis and psoriasis. Neuropathic pruritus, a subset of pruritic conditions including notalgia paresthetica, brachioradial pruritus, scalp dysthesia, postherpetic neuralgia, and itch secondary to spinal cord compression/injury, is unique from other chronically itchy conditions as it is less frequently associated with visible primary dermatologic findings but can be just as bothersome and debilitating.

2020 guidelines for the diagnosis and treatment of cutaneous pruritus.

The mechanisms underlying itch are not fully understood. Physicians usually encounter difficulty controlling itch in generalized pruritus. Since only a small percentage of patients with generalized pruritus respond to antihistamines (H1 receptor antagonists), a variety of itch mediators and mechanisms other than histaminergic signals are considered to be involved in itch for these non-responsive patients. In 2012, we created guidelines for generalized pruritus. Those guidelines have been updated and revised to make some of the definitions, diagnostic terms, and classifications more applicable to daily clinical practice. Cutaneous pruritus as designated in these guidelines is a disease characterized by itch without an observable rash. Generalized pruritus (without skin inflammation) is defined as the presence of itch over a wide area, and not localized to a specific part of the body. This entity includes idiopathic pruritus, pruritus in the elderly, symptomatic pruritus, pregnancy-associated pruritus, drug-induced pruritus, and psychogenic pruritus. Localized pruritus (without skin inflammation) represents fixed itch localized to a specific part of the body, and includes anogenital pruritus, scalp pruritus, notalgia paresthetica, and brachioradial pruritus. These guidelines outline the current concepts and specify the diagnostic methods/treatments for cutaneous pruritus.

Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review.

Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.

Notaljia Parestetikalı Hastalardaki Omurga Patolojileri ve Güçlendirme Egzersizlerinin Kaşıntıyı Gidermede Olumlu Etkisi: Olgu Serisi

Objectives: Notalgia paresthetica is a subgroup of localized neuropathic chronic itch and is due to a nerve entrapment limited to the corresponding dermatome. Neuropathic itching often includes signs of sensitive skin syndrome (numbness, burning, stinging, tingling, etc.). It does not respond to antipruritic treatments used in other itchy dermatoses. The relationship between neuropathic itching and spinal pathology has been reported in many studies. Degenerative disc hernias may play a role in chronic itching localized to the back, hand, and brachioradial areas. We aimed to remind these patients we encountered in our clinical practice. Material and Methods: The files of 12 patients with notalgia paresthetica who applied to our dermatology outpatient clinic between 2016-2018 were reviewed. Diagnostic criteria are: No primary skin lesions in the affected skin area, the absence of any other itchy skin disease, detection of spinal pathology compatible with the itching area in magnetic resonance imaging, no other history of systemic disease or medication to explain itching. Results: Spinal canal stenosis, herniated nucleus pulposus, dural sac compression, and non-compressive bulging and protrusions were seen as spinal pathology. Itching completely disappeared in one of the four patients who conformed to the program, and the itch severity decreased in the other three patients. Conclusion: It should be kept in mind that itching may be of neuropathic origin in patients with localized chronic itching. Spine strengthening and stretching exercises may be a good option as primary or adjuvant therapy in neuropathic itching due to spinal pathology. Advanced clinical studies are needed.

Notalgia paresthetica: An unknown condition by doctors

JRO, a 68-year-old male, with a clinical history of diabetes, complaining of pruritus in the right dorsal topography. The physical examination revealed a pigmented lesion in the affected region, suggestive of notalgia paresthetica (NP) (Figure 1). Treatment with pregabalin 75 mg/day was initiated with good clinical response.

Comparison of itch characteristics and sleep in patients with brachioradial pruritus and notalgia paresthetica: A retrospective analysis from 2 itch centers

Comparison of itch characteristics and sleep in patients with brachioradial pruritus and notalgia paresthetica: A retrospective analysis from 2 itch centers

The etiology of notalgia paresthetica: a descriptive study of 117 patients.

Notalgia paresthetica (NP) is a neuropathic itching condition unilaterally localized in the midscapular area. It is a common but an underdiagnosed disease, and only a few studies investigating NP etiology with a limited number of patients have been reported in the literature. We aimed to evaluate the demographic, clinical, histopathological, neurological, and radiological findings of NP patients and investigate correlations between them and symptoms of NP to elucidate the etiology of NP. One hundred and seventeen consecutive patients diagnosed with NP were included and assessed in a multidisciplinary and prospective manner. We recorded demographic and clinical data and obtained a skin biopsy from the pruritic or hyperpigmented region. Pruritus severity was assessed by visual analogue scale (VAS). All patients were evaluated neurologically with magnetic resonance imaging. The mean age of the patients was 47.08 ± 12.28 years. The disease was more common in females (87.2%). Statistical analysis revealed that VAS scores were independent of the age, gender, and skin type of the patient. We found no significant difference in VAS scores between NP patients with or without comorbidities. Vertebral pathologies detected by MRI and amyloid deposition revealed in histopathology were not among the main factors affecting VAS scores. Since consecutive patients enrolled into the study, we could not include equal number of male and female patients. We found no correlation between symptom severity and findings from neurological and histopathological evaluations. Further microneurological studies should be carried out to elucidate the etiology of NP.

Treatment Modalities for Notalgia Paresthetica Including OMT

Background: Notalgia paresthetica (NP) is a type of neuropathy associated with pruritus, dysesthesias and sometimes pain. Most etiologies stem from trauma and entrapment of cutaneous branches of the upper thoracic nerves.
 Objectives: We report a case of NP treated with osteopathic manipulative therapy (OMT) along with a review of previous treatment modalities performed per the literature.
 Methods: A comprehensive literature search using PubMed was performed on NP and its treatment. Keywords used include notalgia paresthetica, treatment, osteopathic manipulation, neuropathy and pruritus.
 Results: Our patient reported a 30% reduction in severity of pruritus after receiving OMT, with full intention of following up in office for additional treatment.
 Conclusion: OMT monotherapy or combination treatments may prove to be efficacious with little to no added risk.

Notalgia paresthetica: clinical features, radiological evaluation, and a novel therapeutic option

Background/objectiveNotalgia paresthetica (NP) is a sensory neuropathy characterized by localized pruritus and pain, presenting with or without a well-circumscribed hyperpigmented patch in the upper back. Abnormal sensations, such as burning, numbness, and paresthesia are often present in patients with NP. In this study, we clinically and radiologically analyzed patients with NP. The literature contains studies describing lidocaine treatments involving intravenous and topical applications for NP. We also investigated the effect of intradermal lidocaine injection on patients with NP.MethodsA total of 80 patients (45 patients with NP and 35 suffering from dorsalgia without NP) were included in the study. The age, gender and body mass index (BMI) of the patients, and the characteristics of their symptoms were recorded. The severity of pain and pruritus was assessed by the Visual Analog Scale (VAS). Radiography and magnetic resonance imaging of the spine were performed. In this study, we intradermally administered lidocaine diluted with saline into the upper back over three sessions. 1 cc 2% lidocaine was diluted with 5 cc 0.9% saline, and a total of 6 cc lidocaine mixture was obtained. The injection was performed locally at 1-cm intervals around the hyperpigmented patch and segmentally along the C2-T6 spinous processes. These patients were called for a follow-up at the second and fourth weeks and third month.ResultsThere was no statistically significant difference between the two groups in terms of age, BMI, VAS-pain score, and duration of symptoms (p > 0.05 for all). Forty-six cervical and/or thoracic degenerative changes or herniated nucleus pulposus (HNP) were detected in patients with NP. There was a significantly higher number of HNP at the C6–7 segment and cervical degenerative changes in the NP group (p < 0.05). The VAS-pain and VAS-pruritus scores were significantly decreased at all follow-up sessions, and improvement was sustained by lidocaine up to the third month.ConclusionCervical degenerative changes and HNP of the C6–7 segment seem to be contributing factors for NP. Local lidocaine can be effective for pain relief and pruritus in NP.

Intralesional triamcinolone acetonide in notalgia paresthetica: Treatment outcomes in five patients.

Numerous treatment modalities have been tried with diverse results for pruritus due to notalgia paresthetica (NP). Corticosteroids suppress ectopic neural discharges from injured nerve fibers and also have short-lived suppressive effect on transmission in normal C-fibers. Herein, we evaluated the efficacy of intralesional triamcinolone acetonide in the treatment of NP. The medical reports of five patients who had been diagnosed with NP and treated with intralesional triamcinolone acetonide injections were retrospectively evaluated. Triamcinolone acetonide solution was injected intradermally (10 mg/mL; 0.1 mL/cm2 ) every 3 weeks for a maximum of four treatments. The severity of itch was scored by the patients on a combined numerical and visual analogue scale. After treatment, reduction in itch severity scores varied between 33% and 100%.

Gabapentin treatment in notalgia paresthetica: a preliminary report

Gabapentin treatment in notalgia paresthetica: a preliminary report

Case report: notalgia paresthetica

Notalgia paresthetica is a neuropathic pain characterised with hyperpigmentated skin lesion, itch and numbness in scapular region. We summerise three cases with notalgia parestetica and their treatment.

Notalgia paresthetica and neuropathic itch. Case report

ABSTRACT BACKGROUND AND OBJECTIVES: Notalgia paresthetica is a neuropathic sensory syndrome located in the dorsal region between T2-T6 dermatomes and is characterized by a chronic evolution with periods of remission and exacerbation. The objective of this study was to demonstrate a case of notalgia paresthetica, from its clinical and laboratory investigation to the treatment adopted. CASE REPORT: A 77-year-old female patient, retired, attended the Outpatient Pain Service of the University Hospital of the Federal University of Maranhao. The main complaint was severe pruritus in the right dorsal region with extension to the breasts, associated with intermittent pain, burning, shock and tingling, worsening with physical effort and movement. Her sleep quality worsened because of the pain. At the physical examination, no pain was reported on palpation of the site, with mild hypoesthesia in T5 and T6 dermatomes, without altering the thermal sensitivity. She denied a history of skin lesions. The patient received conservative pharmacological treatment, with significant improvement in pain and sleep quality after six months. CONCLUSION: Notalgia paresthetica is a syndrome of unknown etiology, and the lack of studies makes it difficult to optimize the indications and recommendations to direct the treatment. This report illustrates the handling of a case of paresthetica notalgia where gabapentin was used as therapeutic management for pain control, for which it proved to be efficient.

Notalgia Paresthetica

SUMMARY – Notalgia paresthetica is a common, although under-recognized condition characterized by localized chronic pruritus in the upper back, most often affecting middle-aged women. Apart from pruritus, patients may present with a burning or cold sensation, tingling, surface numbness, tenderness and foreign body sensation. Additionally, patients often present with hyperpigmented skin at the site of symptoms. The etiology of this condition is still poorly understood, although a number of hypotheses have been described. It is widely accepted that notalgia paresthetica is a sensory neuropathy caused by alteration and damage to posterior rami of thoracic spinal nerves T2 through T6. To date, no well-defined treatment has been found, although many treatment modalities have been reported with varying success, usually providing only temporary relief.