Notalgia paresthetica (NP) is a condition that causes an intense and sometimes painful itching in your back. It always affects the area between the shoulder blades, but the itch can spread to your shoulders. The name of this disorder comes from the Greek words “notos” for back and “algia” for pain.

Is Notalgia Paresthetica common?

Notalgia paresthetica (NP) is a very common, under-recognized condition. Many people have it and don’t recognize it because for the most part it is harmless.

What are the Symptoms?

Notalgia paresthetica (NP) causes an itch just below either the left or right shoulder blade. The itching can range from mild to severe. People with NP will often rub their backs against a post or wall. Scratching might feel good, but it won’t always relieve the itch.
Other symptoms of Notalgia paresthetica (NP) include:

  • Pain
  • Tingling, numbness, or a pins-and-needles feeling
  • Increased sensitivity to heat, cold, touch, vibrations, and pain

Repeated scratching, itching and rubbing of the area can cause the skin to become thicker and darker in the affected area.

Why does my back always itch in the same spot?

Because Notalgia paresthetica is caused by a problem with a nerve that provides feeling to the skin of the upper back you always feel symptoms along the path of that nerve.

What Causes Notalgia Paresthetica?

It is believed that Notalgia paresthetica (NP) starts when nerves leaving the spinal cord and traveling to the skin get trapped or pinched by muscles in the upper back. Pressure on the nerves damages them and causes the nerves to send messages to your brain that you’re itching or in pain. Some causes of the pinched nerves are back injuries and muscle entrapment. We do not know the cause of Notalgia paresthetica (NP) in all patients.

How is Notalgia Paresthetica Diagnosed?

When itching occurs in this location of the back your doctor will ask about your symptoms and look at your back. They will use this information to rule out other causes of itching such as an allergy or contact dermatitis by clinical examination of the area.

On most occasions the history and physical exam will be sufficient to make the diagnosis of NP, but if there is any uncertainty a biopsy, where a small sample of skin is removed, will be performed in the itchy area for testing. This can rule out other itchy conditions like a fungal infections or lichen sclerosus et atrophicus.

What are the Treatment Options?

Topical creams can reduce the itch but not always eliminate it because the main problem is with the nerve and not the skin. Topical treatments include:

  • Capsaicin cream: this chili pepper derived cream desensitizes the nerve endings to reduce itch.
  • Topical anesthetics like lidocaine deaden the nerves to reduce itch.
  • Corticosteroid creams and injections. These help reduce itch by reducing inflammation.

When the itch is severe or not relieved by topicals NP can be treated with oral medications that more directly treat the nerve damage. These medications include:

  • Gabapentin, Lyrica
  • Tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants

Nerve blocks and botulinum toxin type A (Botox) injections have also been reported to help in some people.

How do you get rid of Notalgia Paresthetica?

There is currently no cure for NP but the treatments listed above are helpful and for most people the symptoms are mild. Many people just want to know why they are itching in that area.

New Treatments

At SullivanDermatology we are currently conducting a clinical trial of a new treatment for NP. For more information click here: Notalgia paresthetica (NP) Trial.

To learn more or if you suspect you have Notalgia paresthetica (NP), please call our office today or book online to schedule a comprehensive consultation.


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