Notalgia Paresthetica is a common condition that predominately affects adults. The main symptom is intense itching, burning, or a tingly feeling present along the inner part of the shoulder blade and the spine. Because of the constant rubbing in this area most patients develop a colored patch. The most common cause of this condition in adults is pressure on a nerve root that gives sensation to the area. If this condition occurs in younger children it can be a sign of a hereditary disorder called Multiple Endocrine Neoplasia 2A.
While treatment is challenging, many different medications and therapies have been used successfully to decrease symptoms. Topical capsaicin cream can be used five times a day for 1 week and then applied three times a day for 3 to 6 weeks. There is initial burning with application but this should decrease overtime. Unfortunately, most patients had symptoms return once stopping the medication. A recent research study revealed that an 8% capsaicin topical patch can be effective.
Other topical therapies that have been used include topical steroids, pramoxine, and a lidocaine/prilocaine mixture. Lidocaine 2.5% and prilocaine 2.5% (EMLA) cream used twice daily was shown to be helpful at reducing symptoms. Oral medications that have had some success are gabapentin (300 mg daily to 300 mg six times daily) and amitriptyline (10 mg once a day). Procedures that have been tried and help ease symptoms include acupuncture, narrow band UVB, transcutaneous electrical nerve stimulation, and spinal nerve block (with a numbing agent and anti-inflammatory agent methylprednisolone) of the nerves that supply the shoulder blade region. Interestingly, two patients had improved symptoms after completing regular back strengthening and flexibility exercises. Osteopathic manipulation has also proved beneficial in case studies.
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