What is the definition of Notalgia Paresthetica?
Notalgia paresthetica is a common chronic, localized itch, that usually affects patches of skin on the upper back. Occasionally it can be more widespread and involve other parts of the back, the shoulders and upper chest. People feel both the sensation of an itch and paresthesia (a sensation of tingling, pricking, or numbness of the skin). There are no signs on the skin except for signs of chronic scratching and rubbing. Amyloid deposits (a collection of a specific type of protein) may be found in skin biopsies, but this is thought to be a secondary event. The cause of the itch in notalgia paresthetica may be due to the compression of spinal nerves by bones or muscles as the nerves emerge through the vertebrae to the back muscles. Sometimes degenerative changes in the area of the vertebrae that innervate the affected back muscles can be seen, but not always. Symptoms of notalgia paresthetica may respond to topical capsaicin treatment.
What are the current treatments for Notalgia Paresthetica?
There is no current treatment for notalgia paresthetica (NP) that is consistently effective. Evaluation and treatment of NP will often involve a multidisciplinary team of specialists. First-line therapy for NP will usually include treatment of the underlying spinal disease by orthopedic surgeons or physical therapists. Topical therapies may include steroid creams, tacrolimus, or capsaicin. Additional therapies have included botulinum toxin injections, gabapentin, physical therapy, nerve blocks, and transcutaneous electrical nerve stimulation (TENS). Some have suggested that a combination of approaches, such as medication along with muscular rehabilitation exercises, may work best.