Notalgia Paresthetica

What is notalgia paresthetica?

Notalgia paresthetica is a condition that causes intense itching, burning or a tingling sensation along the inner part of your shoulder blade on your back. Due to constant rubbing and scratching, most people develop a colored patch on their skin in this area. The condition can last for months to years.

Notalgia paresthetica happens due to irritation or damage to certain nerves. While the condition can be bothersome, it’s not life-threatening or dangerous to your health.

“Notalgia” means “pain in the back,” and “paresthetica” means “burning pain, tingling or itch.”

Who does notalgia paresthetica affect?

Notalgia paresthetica mainly affects adults, especially people over 50. It more commonly affects women and people assigned female at birth (AFAB) than men and people assigned male at birth (AMAB).

If notalgia paresthetica occurs in young children, it may be a sign of a rare hereditary condition called multiple endocrine neoplasia 2A.

How common is this condition?

The frequency of notalgia paresthetica is unknown but it’s thought to be relatively common. Chronic (long-term) pruritus (itchy skin) affects over 20% of people. Notalgia paresthetica is one type of chronic pruritus and represents approximately 8% of all cases of chronic pruritus.

What are the symptoms of notalgia paresthetica?

The main symptom of notalgia paresthetica is itchy skin (pruritus) in the area between the inner part of your shoulder blade and your spine on your back. It usually only affects one side of your back, but it can affect both sides.

Other symptoms include the following feelings in the same area:

• Tingling.
• Numbness.
• Burning.
• Pain.
• Tenderness.
• Heat.
• Cold.

Because it’s almost impossible to resist itching, people with notalgia paresthetica often develop a patch of discolored skin in this area due to constant rubbing.

It’s important to note that notalgia paresthetica doesn’t begin with a rash. It’s a nerve issue, not a primary skin issue. If you have itchy skin with a rash, it could be a different condition.

What causes notalgia paresthetica?

Researchers aren’t completely sure what causes notalgia paresthetica. They think it’s likely due to nerve irritation and/or an abnormal itch control mechanism in your nervous system.

Most researchers agree that it’s a type of neuropathy, but they don’t know if it’s caused by a pinched nerve coming from your back (radiculopathy) or a malfunctioning or injured nerve in your skin (neuropathy).

Several conditions can lead to nerve damage and neuropathy, including:

• Degenerative disk disease.
• Herniated disk.
• Osteoarthritic lesions on your spine.
• Certain metabolic conditions, such as diabetes.
• Certain infections, such as shingles (herpes zoster).

How is notalgia paresthetica diagnosed?

Healthcare providers typically diagnose notalgia paresthetica based on a physical examination and your medical history.

Your healthcare provider will ask about your:

• Symptoms.
• Medical history.
• Current medications.

They’ll also perform a standard physical exam and look at your back.

Providers rarely order medical tests, such as imaging tests or blood tests, to help diagnose notalgia paresthetica. They typically only do this if you have additional symptoms that may suggest you have a neurological or neuromuscular condition.

How do you treat notalgia paresthetica?

Notalgia paresthetica is difficult to treat. It has a wide range of treatment options, but they have varying levels of success. What helps one person may not help another. Treatment temporarily helps improve symptoms, such as itchiness. There’s no cure for notalgia paresthetica.

Treatments include:

• Oral medications: Gabapentin is the most common treatment for notalgia paresthetica. Of all oral medications, it’s the most effective in reducing itchiness. Antihistamine medications can sometimes help with scratching during sleep.
• Topical medications: Topical medications (like creams, lotions and gels) include capsaicin, steroids and anesthetics (such as lidocaine). Capsaicin is the most common topical medication for the condition.
• Botulinum toxin (Botox®) injections: Botox blocks nerve signals that control muscle activity, resulting in relaxation and pain relief. This may help some people with notalgia paresthetica.
• Transcutaneous electrical nerve stimulation (TENS): TENS is a therapy that uses low-voltage electrical current to provide pain relief. One study revealed that using TENS for 20 minutes five times a week resulted in a 60% reduction of itchiness in one-third of the people in the study.
• Spinal nerve block: A nerve block is the injection of a local anesthetic and anti-inflammatory substance close to a targeted nerve, or group of nerves, to lessen pain. Providers inject nerve blocks in the nerves that supply your shoulder blade region to help manage notalgia paresthetica.
• Physical therapy: Physical therapy, specifically targeted at strengthening upper paraspinal muscles and stretching pectoral muscles has helped some people with notalgia paresthetica.

How can I prevent notalgia paresthetica?

Unfortunately, there are no known ways to prevent notalgia paresthetica.

What is the prognosis for notalgia paresthetica?

The prognosis for notalgia paresthetica varies. It can last for months to years. Treatment can help reduce symptoms, and for some people, the condition goes away with time (remission).

While notalgia paresthetica isn’t life-threatening, the symptoms can affect your quality of life and cause discomfort.

When should I see my healthcare provider?

If you’ve been diagnosed with notalgia paresthetica and your treatment isn’t working or you’re experiencing negative side effects, talk to a healthcare provider about other options.

A note from Cleveland Clinic

While notalgia paresthetica isn’t a danger to your health, it can cause unpleasant and uncomfortable symptoms. If the condition is interfering with your quality of life, talk to a healthcare provider. They can recommend treatments. It may take a while to find the solution that works best for you, but it’s worth figuring out.