Physical Medicine and Rehabilitation Role on Notalgia Paresthetica: Case Report and Treatment Review

Neural therapy in notalgia paresthetica

Notalgia Paresthetica (NP) is a type of chronic sensory neuropathy characterized by localized itching, pain and dysesthesias including numbness, tingling, burning, coldness, hypo- and hyperesthesia. It is frequently underdiagnosed and thus, there is no established standard of care for treatment. The objective of our study was to evaluate the efficacy of neural therapy in patients with NP. Patients aged 30-60 years with a diagnosis of NP for at least 6 months were included in our study. Intralesional and segmental neural therapy was administered to the patients in five sessions, with one-week intervals between each session. Patients were evaluated with numeric rating scale (NRS) for pain, the PainDETECT Questionnaire for neuropathic pain, the Short Form-12 (SF-12) for quality of life and the 5-D Itch Scale for pruritus. A total of 12 patients diagnosed with NP were included in the study. The median age of the patients included in the study was 45 years (33-59). 58.3% (n = 7) of the patients were female and 41.7% (n = 5) were male. The median duration of pain was 24 (6-60) months. Itching was observed in 75% (n = 9) and hypoesthesia was present in 58.3% (n = 7) of the patients. Comparisons were made with assessment scales before and 3 months after treatment. There was a significant difference in the pre-treatment NRS, PainDETECT Questionnaire, physical component of SF-12 and 5-D itch scale scores compared to post-treatment. Neural therapy represents a promising complementary treatment method for the reduction of pain, neuropathic pain, and pruritus in patients with NP. Furthermore, it has been demonstrated to enhance quality of life.

Notalgia Paresthetica Review: Update on Presentation, Pathophysiology, and Treatment

PURPOSE OF REVIEW

Notalgia paresthetica (NP) is a chronic cutaneous neuropathy primarily characterized by localized pruritus and associated dysesthesias, including sensations of pain, numbness, and tingling. The sensory neuropathy characteristic of NP is thought to result from spinal nerve entrapment caused by degenerative changes in the spine or musculoskeletal compression. This review summarizes the current medical literature with a focus on the past five years regarding NP, its pathophysiology, presentation, and current treatment options.

RECENT FINDINGS

Though treatments exist with varying efficacy, to date, there exists no definitive treatment for NP. Treatment options for NP are varied and range from topical and oral agents to interventional procedures and physical therapy. Of the treatments evaluated, topical capsaicin remains the most efficacious treatment for NP.

CONCLUSIONS

The lack of established treatment guidelines makes treating NP complicated as it dramatically affects patients' quality of life. Further research with larger sample sizes is needed to evaluate better the most effective treatment and dosing regimen for patients afflicted with NP.

Successful treatment of notalgia paresthetica with lidocaine 5% medicated plaster: a case report

Notalgia paresthetica (NP) is a sensory neuropathy characterized by chronic, localized pruritus in a circumscribed area on the upper back. Pruritus, frequently resistant to treatment, may be accompanied by pain, paresthesia, allodynia and alloknesis. There is a paucity of data in the NP literature about the use of lidocaine 5% medicated plaster. This case involves a 75-year-old woman with NP and a history of many unsuccessful local or systemic treatments. The patient was treated with lidocaine 5% medicated plaster, while other therapies were progressively retired. After 11 weeks of therapy, a significant reduction in the intensity of itching was achieved and the itching area was reduced. The patient also reported an associated improvement in her quality of life throughout therapy. In conclusion, lidocaine 5% medicated plaster was successful in relieving itching and other symptoms in this case of NP.

Notalgia paresthetica: clinical features, radiological evaluation, and a novel therapeutic option

Background/objective

Notalgia paresthetica (NP) is a sensory neuropathy characterized by localized pruritus and pain, presenting with or without a well-circumscribed hyperpigmented patch in the upper back. Abnormal sensations, such as burning, numbness, and paresthesia are often present in patients with NP. In this study, we clinically and radiologically analyzed patients with NP. The literature contains studies describing lidocaine treatments involving intravenous and topical applications for NP. We also investigated the effect of intradermal lidocaine injection on patients with NP.

Methods

A total of 80 patients (45 patients with NP and 35 suffering from dorsalgia without NP) were included in the study. The age, gender and body mass index (BMI) of the patients, and the characteristics of their symptoms were recorded. The severity of pain and pruritus was assessed by the Visual Analog Scale (VAS). Radiography and magnetic resonance imaging of the spine were performed. In this study, we intradermally administered lidocaine diluted with saline into the upper back over three sessions. 1 cc 2% lidocaine was diluted with 5 cc 0.9% saline, and a total of 6 cc lidocaine mixture was obtained. The injection was performed locally at 1-cm intervals around the hyperpigmented patch and segmentally along the C2-T6 spinous processes. These patients were called for a follow-up at the second and fourth weeks and third month.

Results

There was no statistically significant difference between the two groups in terms of age, BMI, VAS-pain score, and duration of symptoms (p > 0.05 for all). Forty-six cervical and/or thoracic degenerative changes or herniated nucleus pulposus (HNP) were detected in patients with NP. There was a significantly higher number of HNP at the C6–7 segment and cervical degenerative changes in the NP group (p < 0.05). The VAS-pain and VAS-pruritus scores were significantly decreased at all follow-up sessions, and improvement was sustained by lidocaine up to the third month.

Conclusion

Cervical degenerative changes and HNP of the C6–7 segment seem to be contributing factors for NP. Local lidocaine can be effective for pain relief and pruritus in NP.