What is Notalgia Paresthetica?

Medically Reviewed By Clare Wightman MS, PAC
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Notalgia paresthetica is a nerve condition that presents on the skin. It typically starts as intense itching on one side of the mid-upper back, causing you to scratch. The continuous scratching results in discoloration of the skin. The actual cause of nostalgia paresthesia is unknown. However, it may occur due to disc degeneration, possibly in the cervical or thoracic region of the back.

This leads to a changing sensation in an area of the skin, usually near the mid-upper back. The new sensations can cause itching, burning, tingling, or loss of sensation in the area.

This article will explain notalgia paresthetica, including symptoms, causes, and how to treat it.

What is notalgia paresthetica?

a shadow of leaves on a back
Sophia Hsin/Stocksy United

Notalgia paresthetica is a condition that includes tingling, itching, burning, tenderness, or loss of sensation on one side of the upper mid-back. It is a form of cutaneous dysesthesia, meaning an unusual or unpleasant sensation in the skin.

Experts believe it results from nerves becoming irritated or compressed. It most likely occurs due to:

  • lower cervical or thoracic spine degeneration
  • a herniated disc
  • a pinched nerve resulting in skin tingling or itching

Read more about nerve pain here.

What are the symptoms of notalgia paresthetica?

Characteristics of notalgia paresthetica include an intense itch on one side of your mid-upper back. This itch, which clinicians call pruritus, can be continuous or intermittent.

It is most common around the shoulder blades. However, it can also appear on the scalp or upper back.

You may experience new sensations in the affected area, such as tingling. This condition may also reduce the ability to sweat in the area it affects.

To test for these symptoms, you can assess whether your skin responds to various stimulants. Hold a pinprick, cotton wool, or something warm or cold against the area and note what sensations you feel.

Other localized symptoms you may experience can include:

  • pain
  • tingling or numbness
  • cold or burning sensation
  • sensitivity
  • pins and needles

Scratching the area may not relieve the itching, but rubbing may be more effective.

In most cases, there are no visible signs. However, changes to the skin can occur due to persistent scratching.

These visible changes can include:

  • scratch marks
  • hyperpigmentation, or darker patches of skin
  • hypopigmentation, or lighter patches of skin
  • eczema
  • scarring
  • lichenification, or thickening of the skin from scratching

Hyperpigmentation and hypopigmentation can often result from itching. Scratching the same areas can cause the skin to thicken and grow darker or lighter.

When should you contact a doctor?

You should consider contacting a doctor if:

  • the itching or tingling persists for multiple days
  • it affects your current lifestyle or ability to carry out tasks
  • it coincides with other symptoms, such as pain, burning, or numbness
  • it spreads past your shoulder blades, toward your shoulder and chest
  • it occurs with sensations that extend down the arm, such as numbness or tingling

What causes notalgia paresthetica?

Researchers do not fully know the cause of notalgia paresthetica. However, it may result from a pinched nerve on one side of the thoracic or lower cervical spine.

The pinched nerve can result from muscle spasms or spinal disc deterioration. Bony growths occurring due to arthritis can also pinch the nerves.

Different conditions can increase pressure on your nerves, including:

  • injury to the back
  • a herniated disc
  • myelopathy, a disease of the spinal cord

How do you treat notalgia paresthetica?

Once your doctor diagnoses notalgia paresthetica, they will determine the best treatment plan for your individual condition.

Treatments seek to address the cause and can include:

  • physical therapy
  • cervical soft collars, or neck braces
  • massages
  • acupuncture
  • neck muscle strengthening
  • exercises to increase range of movement

Creams

The first treatment your doctor may suggest is a cream to help reduce the itching. Recommendations may include numbing or corticosteroid creams, which help reduce your body’s inflammatory response to irritation.

However, these creams are not a curative treatment. They only address the symptoms, not the cause.

Medications

If your symptoms continue to severely impact your lifestyle, stronger treatments may be available. Your doctor may suggest an antiseizure medication, such as gabapentin. These medications can help block pain messages from traveling through the brain and down the spine.

Doctors have had some success treating notalgia paresthetica and neuropathic pain using the antidepressant duloxetine. However, more research is necessary to determine the widespread tolerance of this treatment.

Other medical treatments include oral antihistamine, anti-inflammatory, or muscle relaxant medications.

Surgery

Your doctor may suggest surgery if medication does not effectively treat your severe symptoms. Surgery can help relieve built–up pressure on the nerves.

Doctors typically only recommend surgery for this condition if you have a herniated disc causing your notalgia paresthetica.

Some people may benefit from a paravertebral block, an injection of local anesthetic near the affected region. This process blocks nerve signals as they exit your spine.

Home remedies

The most effective method to relieve your notalgia paresthetica symptoms at home is by applying therapeutic creams. If your doctor does not prescribe a cream, an over-the-counter cream containing menthol may also provide relief.

Certain exercises, such as strengthening your scapular muscles and stretching your pectoral muscles, can improve some notalgia paresthetica symptoms.

Some exercises to try include:

  • lifting your shoulders and rotating them forward, then repeating backward
  • while sitting, crossing your arms and bending your torso forward to stretch out your back muscles
  • rotating the body left and right until you feel a stretch and holding it for several seconds
  • massaging the muscles near the spine

What are the risk factors for notalgia paresthetica?

Notalgia paresthetica typically affects adults more than adolescents, and it is more common in females (sex assigned at birth).

In young adolescents, this condition could suggest multiple endocrine neoplasia 2A, a hereditary disorder.

How do doctors diagnose notalgia paresthetica?

Clinicians usually diagnose notalgia paresthetica by reviewing a patient’s history and conducting a physical examination. The skin may be thick or hyperpigmented in areas that itch or tingle.

If your doctor suspects an injury as the underlying cause, they may suggest a scan to look for damage to your back. Diagnostic scans may include:

Can you prevent notalgia paresthetica?

Avoiding high pressure on your nerves can help prevent notalgia paresthetica. Strengthening the neck and core muscles can help decrease the likelihood of spinal injuries related to the condition. In contrast, scratching at the site of nerve damage can increase the severity of your symptoms.

It is important to seek advice from a doctor as soon as you experience symptoms. Diagnosis includes ruling out several other conditions, which can take time. Early treatment can help prevent your symptoms from worsening.

Summary

Notalgia paresthetica is a condition in which the skin on your upper back discolors and becomes itchy. It is a type of neuropathic pain.

There are many causes of notalgia paresthetica, including high pressure on the nerves in your back.

Treatments can include steroid or numbing creams to treat pain symptoms. Your doctor may recommend medication, personal training, core stretching or strength exercises, and surgery for more severe pain. If your itching and discomfort persist, seek advice from your doctor.

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Medical Reviewer: Clare Wightman MS, PAC
Last Review Date: 2022 Aug 10
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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