A multidisciplinary approach to notalgia paresthetica: The role of physical medicine and rehabilitation specialty

Notalgia paresthetica (NP) is a neuropathic complication which occurs within the innervating field of T2-T6 spinal nerves. The patient complains of burning and itching sensation in the lower part of the inner margin of the scapula, and because of frequent itching,signs of skinscratching and hyperpigmentation are observed in the affected area. The definite cause of this pathology is unclear. Available resources have suggested the followings as the possible causes of the disorder: entrapment of the sensory branches within surrounding muscles, postural abnormalities such as scoliosis and kyphosis and degenerative changes of the spine. NP is usually represented as a rare pathology, however, the relatively common clinical incidence suggests a lack of attention to appropriateidentification, diagnosis and treatment ofthe patients. Diagnosis is done through history taking and physical examination, and there is often no need to additional studiesfor confirmation. A wide spectrum of treatment options have been recommended. Although there is often a tendency to prescribe topical and oral medications for treatment of NP, but application of non-pharmacological therapies such as therapeutic exercises to correct abnormal postures, physical agent modalities such as electrical stimulation and also acupuncture can be effective in accelerating the treatment process and increasing the duration of recovery. Given the undeniable importance of the disorder and its impact on patient's quality of life, a comprehensive approach to existing treatment options with an emphasis on the role of physical medicine and rehabilitation specialists will be discussed in this paper.