Notalgia paresthetica is a nerve condition defined by intense and oftentimes painful itchiness in the back. It typically affects the region amidst the shoulder blades, but the itchiness can radiate to the shoulders and chest.
What are the causes?
In most cases, the precise cause could not be determined. It is believed to start if muscles or bones are trapped and place pressure on the nerves in the upper back.
Some of the possible causes include:
- Herniated disc
- Back injury
- Spinal cord disease
The pressure placed on the nerves limits the blood flow which results to the swelling of the nerves and eventually nerve damage. The swelling and impairment causes the nerves to overly react and transmit signals to the brain that there is itchiness or pain.
What are the signs?
Notalgia paresthetica triggers itchiness just beneath the left shoulder blade. The itchiness can range from minor to severe where the individual is urged to rub the back against a wall. Scratching can provide brief relief, but it will not always alleviate the itch.
Some feel the itchiness on the right side or both sides of the back, beneath the shoulder blade. The itch can spread to the chest and shoulders.
Along with itchiness, the condition can sometimes cause these symptoms to manifest in the upper back:
- Pins and needles sensation
- Numbness, tingling and burning sensations
- Increased sensitivity to cold, heat, pain, vibrations and touch
If the area is scratched, it can cause patches of darker skin to develop on the affected region.
Management of notalgia paresthetica
Drugs are usually given to lessen the swelling and relieve the itchiness temporarily. In most cases, the doctor will utilize the following:
- High-dose capsaicin cream – this works by desensitizing the nerve endings that triggers itchiness. It is applied 5 times a day for a week initially and 3 times a day for 3-6 weeks.
- Local pain control – lidocaine and prilocaine cream in 2.5% can be applied 2 times a day to lessen the symptoms.
- Corticosteroid shots and creams – these can also help reduce the itchiness
The relief provided by these treatment options are generally brief. The symptoms are likely to recur in a few days to weeks after the medications are stopped.
Some doctors suggest gabapentin which is an antiseizure drug. This helps lessen the itchiness in severe cases. In addition, nerve blocks as well as botulinum toxin type A injections can provide lasting relief to the itchiness.