Notalgia Paraesthetica

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Notalgia paresthetica (NP) is a chronic cutaneous sensory neuropathy that causes localized alloknesis and associated dysesthesias, such as pain, numbness, and tingling in the thoracic spine.

Pathophysiology

The precise pathophysiology underlying NP is yet to be fully elucidated. However, a prominent hypothesis suggests that degenerative changes in the spine or musculoskeletal compression leads to impingement of the posterior cutaneous branches of T2-T6 spinal nerves, which subsequently causes a thoracic polyradiculopathy and contributes to the pathogenesis of NP. It is believed that this impingement results in damage to the spinal nerves mentioned above. Patients with NP are more likely to have degenerative cervical and thoracic spine disease than those with back pain without pruritis

It can also occur in small fibre neuropathy.

Epidemiology

The condition has a predilection for those in their middle age and affects women 2 to 3 times more often than men.

Clinical Features

This condition is characterized by hyperpigmentation and chronic scratching and rubbing in the thoracic spine. Typically, the symptoms are unilateral and located in the middle or upper back, medial or inferior to the scapula between T2 to T6.

NP can last for years, with periods of remission and exacerbation. It primarily affects adults, especially women, but hereditary cases have also been reported in younger patients associated with multiple endocrine neoplasia type 2A (MEN 2A).

Treatment

The following have been proposed. Capsaicin seems to have the most research evidence.

Topical agents: capsaicin, tacrolimus, anesthetic cream, and amitriptyline/ketamine

Systemic agents: gabapentin, oxcarbazepine, and TCAs

Procedures: botulinum toxin A and narrowband UVB, and physical therapy.

Other: Exercise, TENS

Resources

Notalgia Paresthetica - Situm 2018.pdf - 678 KB (f)

Notalgia Paresthetica - Robinson 2023.pdf - 1.2 MB (f)

Literature Review

Literature Review

Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf

Articles from all years: PubMed search, Google Scholar search.

TRIP Database: clinical publications about evidence-based medicine.

Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,