Am J Phys Med Rehabil 2018 Apr 9. Epub 2018 Apr 9.

Physical and Rehabilitation Medicine Department and Pain Treatment Unit, Hospital de Braga, Portugal.

Notalgia paresthetica (NP) is a rarely reported T2-T6 sensory neuropathy whose etiology and treatment are not fully established. Although it is believed to be common in dermatological practice, it remains under-recognized, under-diagnosed, and therefore under-reported. This case-report provides a physical medicine and rehabilitation (PMR) perspective on NP diagnosis and treatment. Read More

Int J Dermatol 2018 Apr 15;57(4):388-392. Epub 2017 Dec 15.

Department of Dermatology, Alfred Hospital, Melbourne, Victoria, Australia.

Notalgia paresthetica (NP) is an underdiagnosed condition that presents with unilateral pruritus medial to the scapula on the midback with or without an associated hyperpigmented or hypopigmented macule. There is a paucity of recent reviews on this chronic cutaneous neuropathy in peer-reviewed journals. Current theories propose the condition is likely multifactorial, including spinal entrapment and muscular compressive neuropathy. Read More

Cureus 2017 Sep 28;9(9):e1719. Epub 2017 Sep 28.

Department of Dermatology, University of California, San Diego.

Notalgia paresthetica, a neurosensory syndrome that typically occurs on the upper back, has multiple clinical symptoms with variable degrees of expression in each individual afflicted with the condition. The involved site is usually hyperpigmented and is associated with burning, coldness, hypoesthesia, increased pain, pruritus and/or tingling. In the affected area, the number of nerve fibers may be increased and the cutaneous sensory nerves are altered secondary to localized impingement, central injury, or both. Read More

J Am Board Fam Med 2017 Nov-Dec;30(6):835-837

From the Department Family & Community Medicine, University of British Columbia, Vancouver, BC (RL); Department of Dermatology, Mayo Clinic, Scottsdale, AZ (LAS, DLS).

Notalgia paresthetica is a syndrome of unilateral, chronic pruritis that is associated with burning pain, paresthesia, numbness, and hyperesthesia localized to the medial and inferior scapula. The condition does not respond to anti-inflammatory drugs or traditional antipruritic agents and has variable responses to numerous other reported pharmacologic and nonpharmacologic therapies. Although the etiology is thought to be nerve impingement, neurologic and musculoskeletal causes are often not considered in the differential diagnosis. Read More

Am J Case Rep 2017 Nov 20;18:1225-1228. Epub 2017 Nov 20.

Department of Anesthesiology and Chronic Pain Management, University Hospital of Montreal (CHUM), Montreal, QC, Canada.

BACKGROUND Notalgia paresthetica is a neuropathic condition that manifests as a chronic itch in the thoraco-dorsal region. It is often resistant to treatment, and specific guidelines for its management are lacking. As such, we present a treatment approach with intravenous lidocaine infusions. Read More

J Can Chiropr Assoc 2017 Aug;61(2):128-144

Canadian Memorial Chiropractic College.

Objective: The purpose of this paper is to elucidate this little known cause of upper back pain through a narrative review of the literature and to discuss the possible role of the dorsal scapular nerve (DSN) in the etiopathology of other similar diagnoses in this area including cervicogenic dorsalgia (CD), notalgia paresthetica (NP), SICK scapula and a posterolateral arm pain pattern.

Background: Dorsal scapular nerve (DSN) neuropathy has been a rarely thought of differential diagnosis for mid scapular, upper to mid back and costovertebral pain. These are common conditions presenting to chiropractic, physiotherapy, massage therapy and medical offices. Read More

Int J Womens Dermatol 2017 Sep 21;3(3):131-139. Epub 2017 Jul 21.

Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT.

Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. Read More

Int J Dermatol 2017 Sep 23;56(9):932-938. Epub 2017 Jun 23.

Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy.

Background: Notalgia paresthetica (NP) is a disorder characterized by pruritus localized to the patient's back. Little is known about predictors of severity, duration, side, and localization.

Objective: To identify factors associated with perceived severity, duration, side, and localization of NP. Read More

Noro Psikiyatr Ars 2016 Mar 1;53(1):89-90. Epub 2016 Mar 1.

Clinic of Neurology, Derince Training and Research Hospital, Kocaeli, Turkey.

Pediatr Dermatol 2016 Sep 11;33(5):e303-5. Epub 2016 Jul 11.

Department of Dermatology, Hospital La Paz, Madrid, Spain.

Notalgia paresthetica is characterized by a hyperpigmented macular pruritic skin lesion most commonly localized unilaterally in the middle and upper back region. This condition has been reported in association with multiple endocrine neoplasia syndrome type 2A (MEN 2A) in several families; it rarely affects children and it may serve as an early marker of MEN 2A. We report a 9-year-old girl diagnosed with MEN 2A and notalgia paresthetica. Read More

Pain Med 2016 Jun 21. Epub 2016 Jun 21.

Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Psychiatry Department of Anesthesiology, Pittsburgh, Pennsylvania, USA

Objective: This article presents an evidence-based algorithm to assist primary care providers with the diagnosis and management of lateral hip and thigh pain in older adults. It is part of a series that focuses on coexisting pain patterns and contributors to chronic low back pain (CLBP) in the aging population. The objective of the series is to encourage clinicians to take a holistic approach when evaluating and treating CLBP in older adults. Read More

Pain Pract 2016 06;16(5):E90-1

Department of Pathology, University of Medicine Targu Mures, Targu Mures, Romania.

Agri 2015 ;27(4):224-5

Department of Orthopedics and Traumatology, Ataturk University Faculty of Medicine, Erzurum, Turkey.

Ann Dermatol 2016 Feb 28;28(1):86-9. Epub 2016 Jan 28.

The Allergy Clinic, Copenhagen University Hospital Gentofte, Gentofte, Denmark.

Notalgia paresthetica (NP) is a focal neuropathic itch condition manifesting in intense chronic or recurrent episodic itch in a hyperpigmented, macular, uni- or bilateral skin area located below and/or medially to the scapulae. Achieving satisfactory relieve in NP patients is challenging. In this case-series three female NP patients were treated with 8% capsaicin patches following a spatial quantification of their alloknetic area with a von Frey filament. Read More

J Am Acad Dermatol 2016 Feb;74(2):215-28; quiz 229-30

Department of Dermatology, University of Missouri, Columbia, Missouri. Electronic address:

Dysesthesia is a generic term for a cutaneous symptom--such as pruritus, burning, tingling, stinging, anesthesia, hypoesthesia, tickling, crawling, cold sensation, or even pain--without a primary cutaneous condition in a well-defined location that is often caused by nerve trauma, impingement, or irritation. There are multiple types of dysesthesias depending on the body location and the nerves involved. While location, exact symptoms, and etiologies might vary, the underlying theme is that these conditions are of neurologic origin and have dermatologic consequences. Read More

Dermatol Online J 2016 Nov 15;22(11). Epub 2016 Nov 15.

Department of Dermatology, University of California Davis, Sacramento, CA.

We report a patient with radiation (fluoroscopic)-induced dermatitis that produced symptoms similar to notalgia paresthetica. Read More

Orthopedics 2015 Oct;38(10):e874-80

Managing orthopedic conditions in pregnant patients leads to challenges that must be carefully considered so that the safety of both the mother and the fetus is maintained. Both perioperative and intraoperative considerations must be made based on physiologic changes during pregnancy, risks of radiation, and recommendations for monitoring. Operative timing, imaging, and medication selection are also factors that may vary based on trimester and clinical scenario. Read More

J Eur Acad Dermatol Venereol 2016 Mar 11;30(3):452-4. Epub 2014 Nov 11.

National Skin Centre, Singapore, Singapore.

Int J Dermatol 2015 Jan 14;54(1):e49-51. Epub 2014 Oct 14.

Department of Dermatology, Second University of Naples, Naples, Italy.

An Bras Dermatol 2014 Jul-Aug;89(4):570-5

Universidade Federal do Paraná, Curitiba, PR, Brazil.

Background: notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits.

Objectives: To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica. Read More

Ann Dermatol 2014 Jun 12;26(3):392-4. Epub 2014 Jun 12.

Department of Dermatology, Ajou University School of Medicine, Suwon, Korea.

Notalgia paresthetica refers to an isolated mononeuropathy involving chronic localized itch or paresthesia most often at the skin of the scapula or surrounding regions. There are no specific skin manifestations except those arising from chronic scratching and rubbing. The specific etiology remains unknown; however, it has been theorized that the neuropathic itch is caused by sensory nerve entrapment involving the posterior rami of the T2 to T6 nerve root. Read More

Prog Drug Res 2014 ;68:293-306

Neurogenic pain and pruritus are the common chief complaints at dermatology office visits. Unfortunately, they are also notoriously difficult conditions to treat. Topical capsaicin used as a single therapy or as an adjuvant offers a low-risk option for patients who do not achieve control on other therapies. Read More

J Am Acad Dermatol 2014 Jun;70(6):1139-41

Innovaderm Research, Montreal, Canada.

Actas Dermosifiliogr 2014 Jan-Feb;105(1):74-7. Epub 2013 Dec 27.

Servicio de Dermatología, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.

Introduction: Notalgia paresthetica is a sensory mononeuropathy that affects dorsal segments T2 to T6. It can have a significant effect on quality of life. Numerous treatments have been used with variable results. Read More

Dermatol Pract Concept 2013 Jan 31;3(1):3-6. Epub 2013 Jan 31.

Largo Medical Center, Largo, FL, USA.

Background: Notalgia paresthetica (NP) is a very common, under-recognized condition characterized by pruritus in a unilateral, dermatomal distribution in the mid-back. Chronic pruritus is sometimes accompanied by pain, paresthesias, or altered sensation to touch.

Objectives: To review the current literature with regards to the cause of NP and its most appropriate treatment. Read More

J Dermatol 2013 Jun 27;40(6):505-6. Epub 2013 Apr 27.

JAMA Dermatol 2013 Feb;149(2):200-3

Department of Dermatology, University of Pittsburgh, Pittsburgh, PA 15213, USA.

Background: Scalp dysesthesia is characterized by abnormal sensations of the scalp in the absence of any other unusual physical examination findings. The pathogenesis of this condition is unknown but has been reported in the setting of underlying psychiatric disorders. Other localized pruritic syndromes, including brachioradial pruritus and notalgia paresthetica, have been associated with pathologic conditions of the spine and have been successfully treated with gabapentin. Read More

Dermatol Ther 2013 Mar-Apr;26(2):104-9

Department of Psychosomatics and Psychotherapy, Competence Center of Chronic Pruritus, University Hospital Münster, 48149 Münster, Germany.

Chronic pruritus (CP) is a frequent symptom in the general population; in 8% of all patients, it has a neuropathic origin. CP is of neuropathic origin when nerve fiber damage is responsible for the symptom. The damage can be caused by compression or degeneration of the nerve fibers in the skin or extracutaneous in peripheral nerves or the central nervous system. Read More

Skinmed 2011 Nov-Dec;9(6):353-8; quiz 359

Department of Dermatology, University Hospital Complex of Vigo, Vigo, Spain.

Notalgia paresthetica is a neurocutaneous disorder that most commonly manifests as pruritus and a brownish macula in the patient's upper back. Pain, burning, and paresthesias to a variable degree have also been reported. Although the physiopathology of notalgia paresthetica is still obscure, it is currently considered a sensory neuropathy caused by damage to the spinal nerves. Read More

Semin Cutan Med Surg 2011 Jun;30(2):87-92

Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

Chronic itch can be caused by dysfunctions of itch-sensing neurons that produce sensory hallucinations of pruritogenic stimuli. The cellular and molecular mechanisms are still unknown. All neurological disease categories have been implicated, and neurological causes should be considered for patients with otherwise-unexplained itch. Read More

Acta Derm Venereol 2011 May;91(3):356-7

Emerg Nurse 2010 Nov;18(7):16-8; quiz 19

Caboolture Hospital, Queensland, Australia.

Many patients present to emergency departments with lower back pain, for which there are several differential diagnoses. One of these is meralgia paresthetica, an obscure and benign condition first described in the late 19th century. Nurse practitioners should familiarise themselves with the symptoms of meralgia paresthetica so that they can make differential diagnoses and offer the relevant management. Read More

Int J Dermatol 2010 Aug;49(8):858-65

Complementary Medicine, Peninsula Medical School, University of Exeter and Plymouth, Exeter, UK.

Objective: To determine the efficacy of topical capsaicin in treating pruritus in any medical condition.

Data Sources: Cochrane library, Medline, Embase, Cinahl and Amed, up to April 2008. No language restrictions. Read More

Cutis 2010 Feb;85(2):77-81

Department of Dermatology, University of California, Irvine, USA.

Notalgia paresthetica (NP) is a common refractory, sensory, neuropathic syndrome with the hallmark symptom of localized pruritus of the unilateral infrascapular back. It generally is a chronic noncurable condition with periodic remissions and exacerbations. While the dermatologic syndrome may be multifactorial in etiology, a possible association with underlying cervical spine disease should be evaluated for proper treatment. Read More

J Am Osteopath Assoc 2009 Nov;109(11):605-8

University Hospitals Richmond Medical Center in Cleveland, Ohio, USA.

Notalgia paresthetica is a chronic sensory neuropathy characterized by pruritus of the upper to middle back, typically below the left shoulder blade. Symptoms may include pain, hyperesthesia, paresthesia, and hyperpigmentation of the affected area. Although the etiologic process of this condition is poorly understood, recent correlations with degenerative spinal changes suggest that spinal nerve impingement may play a role. Read More

J Eur Acad Dermatol Venereol 2010 Jun 18;24(6):730-2. Epub 2009 Nov 18.

Department of Dermatology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.

Background: Notalgia paresthesica is a disorder of unknown origin characterized by pruritus localized to the patients' back. Local pain, burning or paresthesias have also been described. No definite treatments have been found for this disorder and most of those reported to date are anecdotal. Read More

Microsurgery 2010 ;30(1):70-2

Division of Plastic Surgery, Johns Hopkins University, Baltimore, MD, USA.

Notalgia paresthetica is a rare nerve compression. From the Greek word noton, meaning "back," and algia, meaning "pain," "notalgia paresthetica" implies that symptoms of burning pain, itching, and/or numbness in the localized region between the spinous processes of T2 through T6 and the medial border of the scapula constitute a nerve compression syndrome. The compressed nerve is the dorsal branch of the spinal nerve. Read More

Pain Physician 2009 Sep-Oct;12(5):881-5

Department of Anesthesiology and Pain Management, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.

Background: Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve caused by entrapment or compression of the nerve as it crosses the anterior superior iliac spine and runs beneath the inguinal ligament.

Objective: We describe the first reported use of pulsed radiofrequency neuromodulation to relieve the intractable pain associated with meralgia paresthetica.

Case Report: A 33-year-old morbidly obese female with a history of lower back pain and previous spinal fusion presented with sensory dysesthesias and paresthesias in the right anterolateral thigh, consistent with meralgia paresthetica. Read More

J Brachial Plex Peripher Nerve Inj 2009 Sep 22;4:17. Epub 2009 Sep 22.

Department of Anesthesia, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Lab, Palo Alto, CA, USA.

Currently, notalgia paresthetica (NP) is a poorly-understood condition diagnosed on the basis of pruritus, pain, or both, in the area medial to the scapula and lateral to the thoracic spine. It has been proposed that NP is caused by degenerative changes to the T2-T6 vertebrae, genetic disposition, or nerve entrapment of the posterior rami of spinal nerves arising at T2-T6. Despite considerable research, the etiology of NP remains unclear, and a multitude of different treatment modalities have correspondingly met with varying degrees of success. Read More

Ann Dermatol Venereol 2009 May;136 Suppl 4:S129-36

Service de Dermatologie, CHU Saint-Jacques, Université de Franche-Comté, INSERM U645, 25030 Besançon cedex.

Botulinum toxin could represent nowadays a new treatment modality especially for cutaneous conditions in course of which conventional treatments remain unsuccessful. Besides palmar and plantar hyperhidrosis, botulinum toxin has demonstrated efficacy in different conditions associated with hyperhidrosis, such as dyshidrosis, multiple eccrine hidrocystomas, hidradenitis suppurativa, Frey syndrome, but also in different conditions worsened by hyperhidrosis such as Hailey-Hailey disease, Darier disease, inversed psoriasis, aquagenic palmoplantar keratoderma, pachyonychia congenital. Moreover, different cutaneous conditions associated with sensitive disorders and/or neurological involvements could benefit from botulinum toxin, for example anal fissures, leg ulcers, lichen simplex, notalgia paresthetica, vestibulitis. Read More

Actas Dermosifiliogr 2008 Nov;99(9):719-22

Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.

Brachioradial pruritus is characterized by the presence of pruritus on the lateral aspect of the arms. The etiology of this enigmatic entity is the subject of some debate some authors claim that brachioradial pruritus is a photodermatosis whereas others attribute it to the presence of underlying cervical radiculopathy. In these case reports, we present our experience with brachioradial pruritus and discuss the role of underlying neuropathy in its etiology and that of other types of localized pruritus such as notalgia paresthetica, anogenital pruritus, and burning mouth syndrome. Read More

Dermatol Ther 2008 Jan-Feb;21(1):32-41

Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, NC, USA.

Neuropathic and psychogenic itch are two entities that have not been well studied. Neuropathic itch is related to pathology located at any point along the afferent pathway of the nervous system. It could be related to damage to the peripheral nervous system, such as in postherpetic neuropathy, brachioradial pruritus, notalgia paresthetica, and in central nervous system damage as a result of spinal cord tumors and demyelinization diseases such as multiple sclerosis. Read More

J Eur Acad Dermatol Venereol 2007 Nov;21(10):1440-1

Arch Dermatol 2007 Aug;143(8):980-2

Division of Dermatology, Newton-Wellesley Hospital, 2000 Washington St, Newton, MA 02462, USA.

J Dermatol 2007 May;34(5):315-9

Department of Dermatology, Adnan Menderes University Faculty of Medicine, Aydin, Turkey.

There is yet no established mode of curative treatment for notalgia paresthetica (NP). We had previously shown a correlation of NP localization with relevant spinal changes which led us to speculate on the possible role of spinal nerve impingement in the pathogenesis of this entity. Based on these findings we aimed to investigate the possible effect of physical therapy in selected cases of NP. Read More

J Chiropr Med 2006 ;5(3):92-6

Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO; Division of Research, Logan College of Chiropractic, St. Louis, MO.

Objective: To present a case of a pregnant patient with meralgia paresthetica who improved using manual therapy and exercise procedures.

Clinical Features: A 22-year-old patient in the sixteenth week of pregnancy had low back pain, bilateral anterolateral thigh paresthesia and groin pain for a duration of 1 month. She had no motor deficits in either lower extremity and her reflexes were intact. Read More

Pain Physician 2003 Oct;6(4):495-7

Georgia Pain Physicians, Emory University, 2550 Windy Hill Road, Suite 215, Atlanta, GA 30067, USA.

This is a case report of a 60 year-old female who presented with pain on the anterolateral aspect of her right thigh. The patient had a history of placement of a Drug Administration System (DAS, Opiate pump) in August, 1998 for chronic lumbar radiculopathy and a multiply operated on spine which she had suffered with since October, 1991. She presented with the subacute onset of focal pain on the anterior aspect of her right superior iliac crest region and dysesthesias on the anterolateral aspect of her right thigh. Read More

Z Orthop Ihre Grenzgeb 2006 Jan-Feb;144(1):40-5

Neurochirurgische Klinik, Leopoldina Krankenhaus, Schweinfurt.

Aim: The authors have conducted a prospective observational study to evaluate the clinical and radiological outcome and complications associated with anterior lumbar interbody fusion (ALIF) using a cage with stabilization.

Materials And Methods: Eighteen patients ranged in age from 36 to 77 years (mean 53 years) who had undergone ALIF were prospectively evaluated. Clinical outcome was graded using a modified Prolo scale (economic, pain, medication) and radiological outcome was recorded (X-rays). Read More

J Am Acad Dermatol 2005 Jun;52(6):1085-7

Department of Orthopaedics, Adnan Menderes University, Aydin, Turkey.

A possible association of spinal pathology with notalgia paresthetica (NP) was investigated through clinical and radiographic evaluation. Forty-three NP patients underwent dermatologic and orthopedic examination accompanied by radiography of the spine. Sixty-one lesions in 43 patients were evaluated. Read More