Notalgia Research Articles

Notalgia paresthetica: a review for dermatologists.

Notalgia paresthetica (NP) is an underdiagnosed condition that presents with unilateral pruritus medial to the scapula on the midback with or without an associated hyperpigmented or hypopigmented macule. There is a paucity of recent reviews on this chronic cutaneous neuropathy in peer-reviewed journals. Current theories propose the condition is likely multifactorial, including spinal entrapment and muscular compressive neuropathy. An extensive literature review was performed by searching the MEDLINE database to review all published works on notalgia paresthetica. This review will provide a useful update for clinicians on the pathogenesis, clinical features, biopsy features, risk factors, and management options for this condition including pharmacological and nonpharmacological methods detailing published treatment options to date for this difficult to treat condition.

Notalgia Paresthetica: A Novel Approach to Treatment with Cryolipolysis.

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.

Poster 445: Treatment with Botulinum Toxin Type A Injection in a Patient with Notalgia Paresthetica: A Case Report

PM&RVolume 9, Issue 9S1 p. S274-S274 Pain & Spine Medicine Poster Hall: Case Report Poster 445: Treatment with Botulinum Toxin Type A Injection in a Patient with Notalgia Paresthetica: A Case Report David Q. Atkins MD, David Q. Atkins MD San Juan VA Medical Center, Carolina, Puerto Rico, Puerto RicoSearch for more papers by this authorEduardo J. Otero-Loperena MD, Eduardo J. Otero-Loperena MD San Juan VA Medical Center, Carolina, Puerto Rico, Puerto RicoSearch for more papers by this authorDavid A. Soto-Quijano MD, David A. Soto-Quijano MD San Juan VA Medical Center, Carolina, Puerto Rico, Puerto RicoSearch for more papers by this author David Q. Atkins MD, David Q. Atkins MD San Juan VA Medical Center, Carolina, Puerto Rico, Puerto RicoSearch for more papers by this authorEduardo J. Otero-Loperena MD, Eduardo J. Otero-Loperena MD San Juan VA Medical Center, Carolina, Puerto Rico, Puerto RicoSearch for more papers by this authorDavid A. Soto-Quijano MD, David A. Soto-Quijano MD San Juan VA Medical Center, Carolina, Puerto Rico, Puerto RicoSearch for more papers by this author First published: 19 September 2017 https://doi.org/10.1016/j.pmrj.2017.08.385Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume9, Issue9S12017 AAPM&R Annual Assembly AbstractsSeptember 2017Pages S274-S274 RelatedInformation

Laser treatment of medical skin disease in women.

Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.

Notalgia paresthetica: factors associated with its perceived severity, duration, side, and localization.

Notalgia paresthetica (NP) is a disorder characterized by pruritus localized to the patient's back. Little is known about predictors of severity, duration, side, and localization. To identify factors associated with perceived severity, duration, side, and localization of NP. In a cross-sectional study, disease severity, duration, side, and localization were compared among the considered variables. Multivariate analysis was used to assess each variable contribution in predicting disease severity and its duration. Sixty-five patients were recruited. Disease involved more female than male patients (Female/Male: 1.6) and after adjusting for all potential confounders, it was perceived as more severe in females (OR = 7.3, 95% CI = 2-26.3, P < 0.01). NP was reported more frequently on the right side among patients sleeping on the left side and conversely (P < 0.05). A higher disease duration was significantly linked to a higher body mass index (OR = 4.8, 95% CI = 1.3-17.1, P < 0.05). Our study linked female gender to worse disease severity, a higher body mass index to longer disease duration, and prevailing sleep position to NP side expression. The sleeping position should be considered a possible target for treating the disease.

Cost-effectiveness of an 8% Capsaicin Patch in the Treatment of Brachioradial Pruritus and Notalgia Paraesthetica, Two Forms of Neuropathic Pruritus.

In brachioradial pruritus and notalgia paraesthetica, the 8% capsaicin patch is a novel and effective, but cost-intense, therapy. Routine data for 44 patients were collected 6 months retrospectively and prospectively to first patch application. The cost to health insurance and the patient, and patient-reported outcomes were analysed (visual analogue scale, numerical rating scale, verbal rating scale for pruritus symptoms, Dermatological Life Quality Index, and Patient Benefit Index). Mean inpatient treatment costs were reduced by €212.31, and mean outpatient treatment and medication costs by €100.74 per patient (p.p.). However, these reductions did not offset the high cost of the patch itself (€767.02 p.p.); thus the total cost to health insurance increased by €453.97 p.p. (p ≤ 0.01). The additional costs of therapy to the patient decreased by €441.06, thus the overall cost p.p. remained approximately the same (€3,306.03 vs. €3,318.94). Capsaicin patch therapy resulted in reduced pruritus, improved quality of life and greater patient benefit, thus long-term cost-efficiency analyses are necessary.

Efficacy of dry needling and kinesiotaping combination in the treatment of notalgia paresthetica: a case report

Efficacy of dry needling and kinesiotaping combination in the treatment of notalgia paresthetica: a case report

A Rare Cause of Neuropathic Pain in the Back: Notalgia Paresthetica.

Notalgia paresthetica (NP) is a neuropathy with unknown cause of thoracic spinal nerves T2-T6, particularly their dorsal branches. It is a chronic disease that can be seen among the elderly and females. Despite its unknown etiology, NP is thought to result from posterior spinal nerve impingement or chronic nerve trauma. In addition, increased dermal innervation and viscera-cutaneous reflex mechanisms are other mechanisms responsible for their chemical neurotoxicity. It is a clinical condition associated with a character of neuropathic pain, itching, and nonspecific skin lesions with brown pigment in both the dorsal vertebrae and scapular areas (1).

Fluoroscopy induced chronic radiation dermatitis should be included in the differential diagnosis of notalgia paresthetica

We report a patient with radiation (fluoroscopic)-induced dermatitis that produced symptoms similar to notalgia paresthetica.

Notalgia paraesthetica: A pilot study of treatment with simple exercises and stretches

Notalgia paraesthetica is a distressing condition for which current treatments are either poorly effective or have unacceptable adverse effects. The aim of this pilot study was to evaluate the effectiveness of a programme of simple exercises and stretches for this condition. In total, 12 patients participated in a trial of simple exercises and stretches over 12 weeks, designed to relieve the sensory neuropathy caused by paraspinal muscle entrapment. Of the 12 patients 11 achieved satisfactory amelioration of their symptoms with no adverse effects. Our pilot study was unblinded and consisted of small patient numbers. Further research to evaluate this approach is warranted.

Efficacy of Dry Needling and Kinesio Taping Combination in the Treatment of Notalgia Paresthetica: A Case Report

Efficacy of Dry Needling and Kinesio Taping Combination in the Treatment of Notalgia Paresthetica: A Case Report

Notalgia Paresthetica as a differential diagnosis of chronic itching: report of two cases

Background Notalgia Paresthetica is part of the differential diagnosis of chronic itching. For years it was confused with one of the clinical varieties of cutaneous amyloidosis, being called “dorsal amyloidosus lichen”, however, it was observed that the deposition of amyloid substance is not the cause, but the consequence of pruritus. It is characterized by itching and hyperpigmentation, usually in the scapular region. Symptoms appears in the areas of T2 to T6 dermatomes and affect more frequently females above 50 years. The pathophysiology involves the anatomical path of the spinal nerves, as well as neuropeptides released by nerve fibers in the peripheral nervous system. Some works relates it to the changes in the spine (compressions, hernias and trauma). The diagnosis is clinical with complementary examinations, such as CT and MRI. There is not a specific treatment, requiring a multidisciplinary approach.

Serratus muscle stimulation effectively treats notalgia paresthetica caused by long thoracic nerve dysfunction: a case series

Currently, notalgia paresthetica (NP) is a poorly-understood condition diagnosed on the basis of pruritus, pain, or both, in the area medial to the scapula and lateral to the thoracic spine. It has been proposed that NP is caused by degenerative changes to the T2-T6 vertebrae, genetic disposition, or nerve entrapment of the posterior rami of spinal nerves arising at T2-T6. Despite considerable research, the etiology of NP remains unclear, and a multitude of different treatment modalities have correspondingly met with varying degrees of success. Here we demonstrate that NP can be caused by long thoracic nerve injury leading to serratus anterior dysfunction, and that electrical muscle stimulation (EMS) of the serratus anterior can successfully and conservatively treat NP. In four cases of NP with known injury to the long thoracic nerve we performed transcutaneous EMS to the serratus anterior in an area far lateral to the site of pain and pruritus, resulting in significant and rapid pain relief. These findings are the first to identify long thoracic nerve injury as a cause for notalgia paresthetica and electrical muscle stimulation of the serratus anterior as a possible treatment, and we discuss the implications of these findings on better diagnosing and treating notalgia paresthetica.

Notalgia Paresthetica Is Not Shown to Improve with Botulinum Toxin Injection

To study the effect of botulinum toxin A on notalgia paresthetica that is resistant to topical therapy and more than mildly pruritic, researchers

Treatment of notalgia paresthetica with botulinum toxin A: A double-blind randomized controlled trial

To the Editor: Notalgia paresthetica (NP) is a chronic sensory neuropathy affecting the interscapular area, especially the T2-T6 dermatomes and characterized by pruritus on the upper back with cutaneous signs associated with rubbing and scratching.1,2 Botulinum toxin A (BTX-A) could have beneficial effects on localized pruritus, possibly by preventing the release of substance P, a mediator involved in pain and itch.3,4 One publication reports complete resolution of pruritus in 2 patients with NP treated with BTX-A.

Notalgia Paresthetica: Treatment Using Intradermal Botulinum Toxin A

IntroductionNotalgia paresthetica is a sensory mononeuropathy that affects dorsal segments T2 to T6. It can have a significant effect on quality of life. Numerous treatments have been used with variable results. Material and methodsFive patients diagnosed with notalgia paresthetica were treated with intradermal botulinum toxin A. None had achieved relief of the pruritus with previous treatments. ResultsVariable results were observed after the administration of intradermal botulinum toxin. Complete resolution of the pruritus was not achieved in any of the patients. ConclusionsBotulinum toxin A appears to be a safe therapeutic option for patients with notalgia paresthetica. However, data currently available come from small patient series, making it difficult to draw definitive conclusions regarding the true efficacy and long-term effects of this treatment.

Tratamiento de la notalgia parestésica con toxina botulínica A intradérmica

IntroductionNotalgia paresthetica is a sensory mononeuropathy that affects dorsal segments T2 to T6. It can have a significant effect on quality of life. Numerous treatments have been used with variable results. Material and methodsFive patients diagnosed with notalgia paresthetica were treated with intradermal botulinum toxin A. None had achieved relief of the pruritus with previous treatments. ResultsVariable results were observed after the administration of intradermal botulinum toxin. Complete resolution of the pruritus was not achieved in any of the patients. ConclusionsBotulinum toxin A appears to be a safe therapeutic option for patients with notalgia paresthetica. However, data currently available come from small patient series, making it difficult to draw definitive conclusions regarding the true efficacy and long-term effects of this treatment.

Chronic itch on the upper back, with pain

An otherwise healthy man has had itchy, grayish-brown patches on his back for 2 years, characteristic of notalgia paresthetica.

Effective treatment of notalgia paresthetica with amitriptyline

The Journal of DermatologyVolume 40, Issue 6 p. 505-506 Letter to the Editor Effective treatment of notalgia paresthetica with amitriptyline Benson Yeo, Benson Yeo National Skin Center, SingaporeSearch for more papers by this authorHong Liang Tey, Corresponding Author Hong Liang Tey National Skin Center, SingaporeCorrespondence: Hong Liang Tey, MBBS, MRCP (UK), MRCPS (Glasg), GDGM, FAMS, National Skin Center, 1 Mandalay Road, Singapore 308205, Singapore. Email: teyhongliang111@yahoo.comSearch for more papers by this author Benson Yeo, Benson Yeo National Skin Center, SingaporeSearch for more papers by this authorHong Liang Tey, Corresponding Author Hong Liang Tey National Skin Center, SingaporeCorrespondence: Hong Liang Tey, MBBS, MRCP (UK), MRCPS (Glasg), GDGM, FAMS, National Skin Center, 1 Mandalay Road, Singapore 308205, Singapore. Email: teyhongliang111@yahoo.comSearch for more papers by this author First published: 27 April 2013 https://doi.org/10.1111/1346-8138.12154Citations: 21Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume40, Issue6June 2013Pages 505-506 RelatedInformation

Neuropathic itch: diagnosis and management

Chronic pruritus (CP) is a frequent symptom in the general population; in 8% of all patients, it has a neuropathic origin. CP is of neuropathic origin when nerve fiber damage is responsible for the symptom. The damage can be caused by compression or degeneration of the nerve fibers in the skin or extracutaneous in peripheral nerves or the central nervous system. There are significant differences in the pathogenesis and in the clinical presentation of neuropathic CP. Localized neuropathic CP such as brachioradial pruritus or notalgia paresthetica are due to a circumscribed nerve compression and are often limited on the corresponding dermatome. In contrast, generalized neuropathic CP, as in small fiber neuropathies, may be associated with a systemic or metabolic underlying disease. It is not always easy to establish the diagnosis because a variety of diseases can be responsible for this type of CP. The present study shows an overview of possible diseases, diagnostic tools, and the relevant therapy strategies.