Notalgia Paresthetica
What is Notalgia Paresthetica?
Notalgia Paresthetica is a condition that causes the skin to become irritated. The irritation or itching can affect one half of your body especially in the mid back area or the region below your shoulder blades. Notalgia paresthetica is also known as interscapular itch or back Scratcher’s itch and it is a benign condition.
This condition can happen at any age but it is prevalent in people who are between 30-55 years of age. Men and women are affected but middle aged and older women experience this condition more than others.
Causes
The real cause of notalgia paresthetica is unknown. However some researchers associate it with a sensory neuropathic syndrome. A sensory neuropathic syndrome is part of degenerative diseases that affect the spine. Research is still going on to proof that nerve impingement causes the symptoms of notalgia paresthetica.
Risk factors
There are various factors that can promote notalgia paresthetica in people. These factors cause injury to the nerves and muscles below your shoulder and in the mid area of your back. Some of these factors include:
- Injury on your neck
- Accidents each from motor vehicle or sports related
- Performing too much weightlifting exercises
- Muscle spasm of the back
- Cervical degenerative osteoarthritis
Symptoms
Patients with notalgia paresthetica feel itchy in their shoulders and below the blades. The itching can also spread and affect other areas of the patient’s body such as the whole back and the top area of your chest.
The itching can become more severe if the patient’s scratches the affected area. This affected area becomes tender to touch and also darker than the surrounding areas.
In some cases itching can be accompanied with feeling of numbness and burning in the affected areas.
Patients may also have difficult in moving the neck and spasm in the cervical muscle. In addition, patients may feel pain in the affected areas which makes them uncomfortable.
Diagnosis
Diagnosis of notalgia paresthetica begins with a thorough physical examination of your skin. Your doctor assesses your symptoms and also studies your medical history to determine the cause of this condition.
Other tests that can be performed include:
Skin biopsy
Your doctor takes a sample of your skin tissue and analyses them in the laboratory under a microscope. A skin biopsy is done to rule out other causes of skin itching.
Imaging tests
Your doctor can also use imaging tests to provide detailed pictures of your spine, neck and head to determine any abnormality. Your doctor can use CT scan for head and neck or MRI scan to identify any injury to your spine.
Electromyogram
Electromyogram (EMG) is a procedure carried out to determine the health of your muscles and nerve cells. This procedure involves the use of electrodes to detect electrical signals in your body. In this procedure, your doctor inserts an electrode needle in your muscles and records the electrical activity of your muscles.
Your doctor also conducts nerve study to measure the speed and strength of signals passing between two or more points in your body. The result may help your doctor know if your nerves and muscles are dysfunctional or there is a problem in transfer of signals between muscles and nerves.
Treatment
The cure of notalgia paresthetica is unknown. However, the main aim of available treatment options is to treat the symptoms of this condition. The following treatment can be used:
Topical treatment
Topical treatment can be used to reduce itching in the affected areas. Your doctor can suggest the following topical treatment:
Capsaicin
Research has shown that capsaicin is effective in relieving itching symptoms of notalgia paresthetica. Capsaicin is a molecule that is obtained naturally and it has transient receptor potential vanilloid properties. It is used to reduce the temperatures in your affected areas so that the nerves operate well and relieve pain and itching.
You can use corticosteroids to treat the symptoms of notalgia paresthetica for a short while. Other alternatives you can use include lidocaine.
Antiseizure medications
Antiseizure drugs can also be used to reduce pain and irritation in the affected areas. These drugs can prevent sodium on the neurons that produce pain to minimize irritation and pain in patients with notalgia paresthetica. Your doctor can prescribe antiseizure medications such as oxcarbazepine, gabapentin and tricyclic antidepressant amitriptyline.
Muscle relaxants
Muscle relaxant drugs can be used to treat muscle spasm or spasticity. These drugs are widely recommended but their effectiveness is sparse. Your doctor can prescribe the following drugs: baclofen, acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDS (aspirin, naproxen) to reduce pain in your neck and shoulder.
Surgery
Your doctor can perform cervical discectomy with fusion to reduce pain, numbness and stiffness. Your doctor can conduct this surgery from the front part of your neck and remove the disc in the neck. Your doctor also performs fusion surgery to stabilize the cervical segments. Fusion surgery involves implanting a bone graft in the place where the disc was to strengthen the area.
Exercise or physical therapies
One of the causes of notalgia paresthetica is systemic disorders such as degenerative diseases of the spine. The symptoms of these diseases such as pain, rigid and difficult of motion in some parts of your body can be reduced through physical therapy.
Your doctor can recommend you to a physiotherapist to help you in exercising. Your physiotherapist can show you the following exercises:
Spinal manipulation
In this therapy, your physiotherapist combines various forms of therapies such as massage, moving and jolting joint and exercises. The aim is to help you reduce pressure on your joints, inflammation and enhance the functioning of your nerves. Spinal manipulation is used to treat pain in your shoulder, neck, back and headache.
Transcutaneous electrical nerve stimulation
It is a type of therapy that uses low voltage electric current to ease pain. Your physiotherapist uses a powered battery and two electrodes. The electrodes are placed on the affected skin which produces a circuit of electrical signals that travels in your skin to relieve pain.
Tips to Reduce the Risks
There is no specific method of preventing notalgia paresthetic. However, one can reduce exposure to risks that may develop this condition. You can do the following:
- Avoid scratching affected areas because this can attract infections from microorganisms.
- Minimize your weightlifting exercises
- Use proper sports facilities to prevent injury on the whiplash.
Reference List
- Notalgia Paresthetica. Available at http://www.dovemed.com/diseases-conditions/notalgia-paresthetica/
- Transcutaneous Electrical Nerve Stimulation (TENS). Available at http://www.webmd.com/pain-management/tc/transcutaneous-electrical-nerve-stimulation-tens-topic-overview
- What Is Spinal Manipulation? Available at http://www.healthline.com/health/back-pain/spinal-manipulation
- Electromyography (EMG). Available at http://www.mayoclinic.org/tests-procedures/emg/basics/definition/prc-20014183
- http://emedicine.medscape.com/article/1599159-overview#a2
- https://www.practicalpainmanagement.com/pain/spine/referred-back-pain/notalgia-paresthetica-enigmatic-condition
- https://www.epainassist.com/skin/notalgia-paresthetica
- Notalgia Paresthetica. Available at http://diseasespictures.com/notalgia-paresthetica/
- Anterior Cervical Discectomy and Fusion. Available at http://www.spine-health.com/treatment/spinal-fusion/acdf-anterior-cervical-discectomy-and-fusion
