Notalgia Paresthetica: Symptoms and Treatment

Notalgia paresthetica (NP) is a nerve disorder that causes intense and sometimes painful itching in your back that can impact your quality of life. It usually affects the area below one of your shoulder blades, but the itch can spread to your shoulders and chest.

A recent studyTrusted Source suggests that NP may be somewhat common, but possibly underdiagnosed. According to research from 2021Trusted Source, NP is part of a subcategory that likely makes up around 8 percent of cases of chronic pruritis.

Chronic pruritis is a kind of persisting itchy skin. It affects over 20 percentTrusted Source of the population at some point in their lives.

The name “notalgia paresthetica” comes from the Greek words “notos” (back) and “algia” (pain).

NP causes an itch just below your shoulder blade. The itching can be mild, or it can be so severe that it makes you want to rub your back against a post or wall. Scratching might feel good, but it won’t always relieve the itch.

You may feel the itching on either one or both sides of your back. The itch can also spread to your shoulders and chest.

Along with itching, NP can sometimes cause these symptoms in the upper back:

NP usually has no visible symptoms. However, repeatedly scratching the itch can cause patches of darker-colored skin to appear in the affected area.

Doctors don’t know exactly what causes NP. They think it starts when bones or muscles trap and put pressure on nerves in the upper back. The angle at which the nerves come through the muscles around your spine may make them more prone to irritation from muscle movements.

Possible causes include:

Pressure on the nerves restricts blood flow, makes the nerves swell up, and leads to nerve damage. Irritation and damage cause the nerves to overreact and send messages to your brain that you’re itching or in pain when you aren’t.

Less often, NP affects people with multiple endocrine neoplasia type 2A (MEN 2A). In this inherited condition, the gene mutations that cause other symptoms may also result in NP.

The American Osteopathic College of Dermatology says that NP usually only affects adults. According to research from 2020Trusted Source, NP mostly occurs in women between the ages of 54 and 62. With MEN 2A, though, children can have it as well.

NP can last for months or years. While it may completely subside in some cases, this doesn’t happen for everyone. It may also appear to go away before coming back again later.

No single treatment works for all cases of NP. Still, your doctor can likely find a treatment option or combination of treatments that’s effective for your symptoms.

Itching is a very general symptom. Many different conditions can cause it. Your doctor will rule out other common causes of itching, like contact dermatitis or psoriasis, when making a diagnosis.

Your doctor will ask about your symptoms and look at your back. They might remove a small sample of skin in the itchy area for testing. This is called a biopsy. It can help rule out other itchy skin conditions like a fungal infection or cutaneous amyloidosis.

If your doctor suspects that an injury caused your symptoms, you might have one of these imaging scans to look for damage to bones or other structures in your back:

  • X-ray
  • CT scan
  • MRI scan

Currently, there’s no treatment for NP that is effective for everyone. People with mild or only occasional itching may also not need treatment.

Some medications can help relieve the itch temporarily. Doctors may use the following to treat NP:

  • Gabapentin (Neurontin). This antiseizure drug is commonly used to treat NP and reduce itching. Mild stomach pain may be a side effect of the medication.
  • Capsaicin cream. This may offer some relief from itching, but often causes a burning feeling. You can use it 5 times per day for 1 week and then 3 times per day for 3 to 6 weeks. Capsaicin also comes in patch form.
  • Local pain relievers. Lidocaine 2.5 percent and prilocaine 2.5 percent cream twice a day may help reduce symptoms.
  • Corticosteroid creams. These may also help with the itch. However, they’re only effective if you have inflammation.

Any relief you get from these treatments is likely to be short-lived. Symptoms often come back within a few weeks to months after stopping the medication.

Nerve blocks and botulinum toxin type A (Botox) injections might offer longer-lasting relief from itching. However, some research from 2014 has found limited or no improvement from using Botox. It’s important to note that the study only included 5 participants. More research with larger groups of people needs to be done.

A recent case report also indicated that duloxetine, a serotonin-norepinephrine reuptake inhibitor typically used to treat depression, helped treat one patient’s itching.

Other treatments that may improve NP symptoms include:

To get relief from the itch and pain of NP at home, try applying a cooling cream to your back. Look for a product that contains ingredients like camphor or menthol.

small study from 2015Trusted Source suggested that exercises may improve NP. Stretching and strengthening your muscles may help reduce the angle at which nerves come through the muscles around your spine. This may ease nerve irritation and improve your itch.

Here are a few exercises to try:

  • Stand with your arms at your sides. Lift just your shoulders and rotate them forward. Then reverse the movement, rotating your shoulders backward.
  • Hold your arms straight at your sides and rotate them forward all the way around until they’re back resting at your sides. Repeat, rotating your arms backward.
  • While sitting, cross your arms and bend forward to stretch your back.

NP isn’t cancer. Although skin changes can sometimes be a symptom of cancer, the Dana-Farber Cancer Institute says that itchy skin is rarely a sign.

Melanoma skin cancer may itch. But melanoma looks like a mole and can be on any part of your body, not necessarily on your back.

A blood cancer called polycythemia vera causes itchiness after a warm shower or bath, but itching is just one of its many symptoms. Other signs include dizziness, headache, fatigue, and trouble breathing.

In some cases, itchy skin can be a sign of leukemia or lymphoma.

Itching in your upper back could be caused by any number of things, from skin irritation to a fungal infection. You may be able to treat it yourself at home.

Contact your doctor if the itching:

  • doesn’t go away after a few days
  • is intense
  • started after a back injury
  • happens with other symptoms, such as numbness, tingling, or pain in the area
  • spreads to other parts of your back

NP has no known cure, but different treatment options can help relieve your symptoms.

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