NP = Notalgia (Greek for pain in the back) Paresthetica (a sensation of pricking, tingling, or creeping on the skin that has no objective cause) is nothing new. The condition was first identified in medical literature by a neurologist from St. Petersburg, Russia in 1934. It has, nevertheless, likely been around since humans started walking upright and may be the reason back scratchers .... or long finger nails were invented. One wonders if bears scratching up against a tree are afflicted with the same curse.
NP is characterized by pain, numbness, and itching between the inside edge of the scapula (shoulder blade) and the spine. It is typically on the left side - less often on the right side - and some 10% of presentations are on both sides. It is fairly common condition with a low grade irritation that comes and goes, and most will not bother to report the nuisance to their physician. In fact, many physicians are unfamiliar with NP as a clinical problem. However, for some people the irritation becomes distracting to the point of interference with life quality.
As with any irritation, a scratch may give temporary distraction, but scratching creates a secondary inflammation response in the skin... which then makes the itching worse! (This is the same reason that a mosquito bite does get itchier each time you scratch it). So it gets to be a progressive cycle of itching - scratching - more itching - more scratching.
With persistent scratching and rubbing over a longer period of time, the skin begins to change, becoming thicker, rougher, and discoloured ... resembling a patch of psoriasis. The irritated skin then becomes its own source of annoyance regardless of the NP being underlying cause. Scratching the skin can also create access for bacteria and lead to secondary infections. For some people the irritation becomes a psychological fixation which further amplifies the awareness of the discomfort due to the effects of the underlying NP.
NP itself is not a dangerous condition. It is the nuisance to the point of distraction, repeated scratching, development of secondary effects of skin irritation and perhaps infection, and perhaps depression that become problematic.
There is no definitive cause for the condition. Speculation ranges from an overly dense concentration of itch sensitive nerve fibers in the area, to degenerative changes at a cellular level of the skin. It is quite possible that those changes are brought on by the rubbing to relieve the condition, rather than being the cause of NP.
Treatments are typically directed at relieving the secondary symptoms of skin irritation and numbing the primary itching. Counter irritants such as capsicum ointment may give the brain something to attend to rather than the more annoying itch. Extreme cases have resorted to more extreme methods of relief such as surgical destruction of the affected nerves. Various medications acting on nerve pain and antidepressants such as amitriptyline may help. While these methods may be well intentioned and variably helpful, they are at best, it seems, only chasing the problem.
Please note: Numbness, itching, irritation, and pain can be symptoms of nerve compression and/or irritation.
NP is most commonly seen in individuals with some type of neck trouble and potentially a history of whiplash, car accident(s), heavy lifting, computer work, other neck injuries, arthritis, fibromyalgia, and hypertense muscles. There is a positive correlation between the presence and severity of NP with the presence and severity of spinal degenerative arthritis. The theory is that conditions such as poor posture habits, upper body weakness, upper cross syndrome, occupational stress, tech/text neck create cumulative strain and micro trauma. Typically there is increasing inflammation of the muscles of the neck and back, along with advancing degenerative changes in the both the cervical and thoracic spine.
When there is stress on the muscles and joints of the spine, fibers of the nerves that provide sensation to the skin of the back can become compressed and/or irritated due to herniated or bulging discs and degenerative arthritis, and/or sustain traction/compression /irritation as they progress through chronically strained and irritated muscles of the upper back.
Many people have experienced relief/reduction of NP after spinal manipulative therapy and supportive physical therapy to correct posture, spinal mechanics, and relieve nerve compression. This supports NP as being caused by mechanical stress on the cutaneous branches of the thoracic nerves.
There is a similar condition of pain and itching of the arms called Brachioradial pruritus (sometimes abbreviated BRP) that has been successfully treated by spinal manipulative therapy.
Spinal manipulative therapy is a method that chiropractors use to "adjust" the alignment of the bones (vertebrae) of the spine. This re-aligns and opens the joints to relieve pressure and irritation of the nerves and other pain sensitive tissues.
Certainly correcting spinal alignment and managing ongoing postural and physical stresses is beneficial to any patient…and if it is successful in providing relief of compressed and irritated nerves, it would help the patient manage the cause of NP rather than just chasing it symptomatically.
NP tends to be a chronic condition with periodic remissions and flareups. Very early stages of NP may clear fully with appropriate spine therapy, and lifestyle and posture modifications. For more advanced cases with underlying neck and upper back nerve issues, NP it is not necessarily curable but may be controllable.