What Is It?
Notalgia paresthetica is a common and annoying condition that causes itchy spots along the edge of the shoulder blade. It’s a place that is hard to reach, so people have been known to try to scratch the area with forks, back scratchers, door frames, and other creative instruments!
The itch may come and go and may even occur in “fits” for a few days and then settle back down. Yet when you have someone check for what might be the cause, usually there isn’t anything on the skin surface. Over time, however, the skin may be slightly darkened and thickened from all the scratching. Some patients say the spot is painful or has a “pins and needles” feeling instead of, or in addition to, the itch. And while the shoulder blade is the most common spot, it can also occur in other places on the back, neck, and even on the chest.
What Causes It?
Notalgia paresthetica has been associated with neck arthritis. There are small nerves that leave the spinal cord in the neck and travel to the skin to provide sensation. But when arthritis causes a small bone spur, the nerve can become irritated from time to time when the spur rubs up against the nerve, creating that itchy sensation. Many patients tell us they knew they had arthritis in the knees or hands but were unaware that they had neck arthritis.
Since this is a skin symptom due to underlying arthritis, we tell patients there is no cure, just as there is no cure for arthritis. We also don’t have one perfect treatment that relieves the itch in all patients; we just try to work with patients to find a treatment that makes this condition less aggravating.
Over-the-Counter Cream Options
Some of these creams have different ingredients, but most have a topical antihistamine called pramoxine. Some also have ingredients like menthol, which help cool and soothe the skin.
- Sarna® Original Anti-Itch Lotion
- Sarna Sensitive Anti-Itch Lotion
- Sarna Ultra Anti-Itch Lotion
- Gold Bond® Anti-Itch Lotion
- Capsaicin: not the same method of action as the others. This one causes intense burning until it stops both the itch and the burning. Must be used regularly to continue working.
Prescription Cream Options
- Lida-Mantle® Lotion or Cream: contains lidocaine for numbing.
- Topical steroids: calm any underlying inflammation of the skin. Cannot be used every day for a long time, because they can thin the skin.
- Compounded creams that have various ingredients like amitriptyline, gabapentin, lidocaine, etc.
Other Potential Treatments
- Botox® injections to the area have been reported to be very helpful for some, but will not be covered by insurance since Botox is not approved for this purpose.
- Acupuncture
- Chiropractics
- Osteopathic manipulation
- Special exercises to strengthen the neck muscles (see below)
Gentle Exercises
Neck retractions
- Stand or sit straight with your shoulders relaxed, eyes straight forward, chin slightly tucked (not raised).
- Without tilting your head up or down, gently pull your head straight backwards as if you’re trying to make a double chin.
- Hold for 3–5 seconds.
- Slowly return your head to the neutral starting position without jutting your chin forward past neutral.
- Repeat 10–15 times per session, 1–2 times daily.
Chin rolls
- Sit tall with your feet flat on the floor and shoulders relaxed.
- Tilt your chin down so it is aimed at the armpit.
- Slowly and gently guide your chin along your chest, moving your chin toward the other armpit.
- Repeat 5 times per session, 1–2 times daily.
Have questions about that itchy spot on your back, or want me to take a look? You can book online or call the office at 423-528-8833. This page is for general education, not a substitute for a personal exam.