Overview
Notalgia paresthetica is a sensory neuropathy characterized by localized pruritus and pain, often accompanied by hyperpigmentation and abnormal sensations in the upper back, typically involving thoracic nerves T2 through T6 12.Diagnosis
Clinical Presentation: Localized pruritus, pain, burning, numbness, and paresthesia in the upper back 12.
Physical Examination: Presence of hyperpigmented patches may be noted 1.
Imaging: Radiography and magnetic resonance imaging (MRI) of the spine can rule out other spinal pathologies 1.
Severity Assessment: Use Visual Analog Scale (VAS) for pain and pruritus intensity 1.Management
First-Line Treatments:
- Topical Agents: Not specifically detailed in abstracts, but commonly used.
- Intradermal Lidocaine Injections: Diluted 2% lidocaine (1 cc diluted with 5 cc 0.9% saline, total 6 cc administered over three sessions) shows promise 1.
Adjunctive Treatments:
- Physical Therapy: Not detailed in provided abstracts.
- Psychological Support: Consideration for chronic pruritus management, though not explicitly mentioned 1.Special Populations
No Specific Data: Limited information on management in pregnancy, pediatrics, elderly, or with comorbidities from the provided abstracts 12.Key Recommendations
Evaluate with Imaging: Utilize radiography and MRI to exclude other spinal causes of symptoms (Evidence: Moderate 1).
Consider Intradermal Lidocaine: Intradermal lidocaine injections may be effective for symptom relief; administer diluted lidocaine over multiple sessions (Evidence: Weak 1).
Assess Severity: Use VAS to quantify pain and pruritus severity for monitoring treatment efficacy (Evidence: Expert opinion 1).References
1 Mülkoğlu C, Nacır B. Notalgia paresthetica: clinical features, radiological evaluation, and a novel therapeutic option. BMC neurology 2020. link
2 Massey EW, Pleet AB. Localized pruritus-notalgia paresthetica. Archives of dermatology 1979. link
3 Massey EW, Pleet AB. Handcuffs and cheiralgia paresthetica. Neurology 1978. link