Notalgia Paresthetica

[nanadi_49]

I was diagnosed with Notalgia Paresthetica several years ago but suspect I've had it for a very long time.  I have constant "driving me insane" itching below my left shoulder blade and often times I get burning stinging pain under my left breast along with pain in my left breast/nipple area.  I have tried lidoderm patches, neurontin and more recently radio frequency ablation the latter of which can sometimes keep the pain part at bay for almost a year but absolutely nothing helps this itching.  I also have numbness and tingling in my upper left back.  I have searched the internet endlessly for causes for and help (if there is any) for this condition but to no avail.  I have seen info about long thoracic nerve injury and serratus muscle injury.  There has also been literature to suggest the long thoracic nerve (if that is the cause) originates in the cervical spine area?  I have also come across info suggesting that a nerve could be compressed but MRI's are normal.  Another doctor at the Lahey Clinic in the Boston, MA area said a virus could have been the cause?  Anyway does anybody else have this condition and/or does anybody out there have any suggestions as to what might help or where I can maybe turn to for help....this itching is horrible...ironically it, the itching doesn't bother me when I'm sleeping but I have awakened in the night with that under the left breast pain thing...

[nanadi_49]

You mentioned herpes zoster in your answer.  What I was wondering is can one have residual from chicken pox in more than one area?  Three years ago I had shingles.  The rash was on my right buttock and right inner aspect of my right thigh.  My dermatologist said the virus was hanging out in my lumbar spine.  What I described above first happened when I was 10 years old and I didn't get chicken pox until I was 12.  The only thing my dermatologist did was give me a script for lidoderm patches which don't help as I find myself scratching through the patch.  He mentioned a physiatrist but I'm not sure if I should go there or to a neurologist?  Don't know of any in the Tampa, FL area where I live.  I have also heard of a type of MRI called neurography which is suppose to be better than a traditional MRI in that it "sees more."  Regarding the long thoracic nerve....this could be part of the problem and I have heard it originates in the cervical spine where I do have some issues but no herniated discs.  Also I have heard about possible serratus muscle rehabilitation but do you know what that involves and who would I see about that?  I still think there could be an impingement thing going on as research I've done on NP does present that as a cause.  There is also a heredity factor as I remember my father itching his back in a door post but I don't recall him ever mentioning pain.  Hope to hear back from you.....take care, Dianne

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Notalgia Paresthetica is a localized itch usually in the shoulder blade area, i.e., between T2-6, that may also be associated with pain, numbness, or skin color changes. Typically, dermatology diagnose this condition and manage. The first line medicines are topical capsaicin and corticosteroids. Additionally, local anesthetic may be useful. Neuropathic medicines have been tried, such as various antiepileptics, but with poor success.

I would suggest you follow up with a dermatologist. It is important to diagnose this and differentiate it from another condition such as herpes zoster.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.