7 Notalgia Paresthetica Facts Every DC Must Own
Notalgia paresthetica is a frequently overlooked cause of interscapular itching and paresthesia. Fortunately, this common complaint responds quite favorably to chiropractic management.
This blog and video provide a quick synopsis of the essentials you’ll need to become the provider of choice for managing notalgia paresthetica.
1. What Is Notalgia Paresthetica?
Notalgia paresthetica, aka Itchy Back, is a prevalent yet underrecognized cutaneous sensory neuropathy, causing unilateral interscapular itching, paresthesia, or altered sensation. (1) If undiagnosed, the symptoms may last for years. (1,2) And chronic itch can impact the quality of life to the same extent as pain. (3)
2. What Causes Notalgia Paresthetica?
Irritation to the cutaneous branches of the dorsal spinal nerves causes aberrant nociceptor/ pruriceptor firing, with subsequent symptoms. (1,4-7) Potential triggers include degenerative spinal encroachment or myofascial constriction as the nerves traverse the paraspinal musculature. (1,5,8-18) The cutaneous nerves are thought to be most vulnerable to irritation where they exit the paraspinal muscles at acute angles. (1,8-11,18)
3. Who Gets Notalgia Paresthetica?
The condition typically affects middle-aged and older adults and is rare in pediatric populations. (4,7,20,21) Females represent 62-87% of cases. (4,7,15,19,20) The condition is more common in workstation users and others who must sustain prolonged flexion-biased positions that stretch vulnerable tissues. (4)
4. What Are the Symptoms of Notalgia Paresthetica?
Variable unilateral paresthesia, itching, burning, tingling, or dysesthesia on a small patch of skin between the spine and inferior scapular border, usually between T2-T6. (1,4,5,7,13-15,21) Occasionally, patients display a corresponding hyperpigmented patch secondary to repetitive scratching. (21) The condition is more common on the non-dominant side. (5,7,15) A high percentage of patients suffer from concurrent cervical spine-related issues. (13,22)
5. How is Notalgia Paresthetica Diagnosed?
The diagnosis is based upon the history and exclusion of alternate diagnoses, particularly cervical radiculopathy. (1) The keys to successful subsequent management include identifying: thoracic and cervical spinal joint dysfunction, paraspinal hypertonicity, and postural stressors, including upper crossed syndrome.
6. How is Notalgia Paresthetica Treated?
Clinicians should direct treatment at the underlying musculoskeletal issues instead of masking symptoms. (4,13,23) Primary in-office tools include:
Manipulation of any thoracic or cervical joint restrictions. (1,21,24,25)
Myofascial release and STM to the paraspinal and interscapular muscles.
TENS may provide benefit. (4,12,26)
One study showed that acupuncture resolved neurogenic pruritus complaints (including notalgia paresthetica) in 12 of 16 cases. (27)
7. What Home Care Helps Notalgia Paresthetica?
Postural re-education is crucial. Exercises to stretch the pecs and strengthen the upper thoracic spinal extensors may decrease chronic postural stress and reduce the acute exit angle of the cutaneous nerves. (26,28)
ADL advice must include a discussion of proper workstation ergonomics for seated, standing, and laptop environments. Download all 3 of these patient infographics in ChiroUp’s Forms Library!
Seated Workstation
Laptop Ergonomics
Standing Workstation
Seek alternatives to excessively compressive bra straps.
Capsaicin and counterirritant creams may provide palliative benefit. (29-31) However, antihistamine or steroid creams do not typically provide lasting benefits and may carry undesired side effects. (1,32)
Conclusion
Notalgia paresthetica arises from chronic physical irritation and a dysregulated itch control mechanism. (33-35) Successful management requires identifying and eliminating chronic postural stress, spinal segmental joint dysfunction, and the associated paraspinal muscle hypertonicity. Chiropractors are uniquely suited to be the provider of choice for managing this common, yet frequently underdiagnosed, complaint.
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