Notalgia paresthetica: clinical features, radiological evaluation, and a novel therapeutic option

BACKGROUND/OBJECTIVE: Notalgia paresthetica (NP) is a sensory neuropathy characterized by localized pruritus and pain, presenting with or without a well-circumscribed hyperpigmented patch in the upper back. Abnormal sensations, such as burning, numbness, and paresthesia are often present in patients with NP. In this study, we clinically and radiologically analyzed patients with NP. The literature contains studies describing lidocaine treatments involving intravenous and topical applications for NP. We also investigated the effect of intradermal lidocaine injection on patients with NP. METHODS: A total of 80 patients (45 patients with NP and 35 suffering from dorsalgia without NP) were included in the study. The age, gender and body mass index (BMI) of the patients, and the characteristics of their symptoms were recorded. The severity of pain and pruritus was assessed by the Visual Analog Scale (VAS). Radiography and magnetic resonance imaging of the spine were performed. In this study, we intradermally administered lidocaine diluted with saline into the upper back over three sessions. 1 cc 2% lidocaine was diluted with 5 cc 0.9% saline, and a total of 6 cc lidocaine mixture was obtained. The injection was performed locally at 1-cm intervals around the hyperpigmented patch and segmentally along the C2-T6 spinous processes. These patients were called for a follow-up at the second and fourth weeks and third month. RESULTS: There was no statistically significant difference between the two groups in terms of age, BMI, VAS-pain score, and duration of symptoms (p > 0.05 for all). Forty-six cervical and/or thoracic degenerative changes or herniated nucleus pulposus (HNP) were detected in patients with NP. There was a significantly higher number of HNP at the C6–7 segment and cervical degenerative changes in the NP group (p < 0.05). The VAS-pain and VAS-pruritus scores were significantly decreased at all follow-up sessions, and improvement was sustained by lidocaine up to the third month. CONCLUSION: Cervical degenerative changes and HNP of the C6–7 segment seem to be contributing factors for NP. Local lidocaine can be effective for pain relief and pruritus in NP.