Is Notalgia Paresthetica Linked to Cancer?

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Notalgia paresthetica (NP) is the presence of an intense burning, itching, or tingling feeling between the shoulder blades (along the spine). This part of the back is an inconvenient place to have an itch because it’s unreachable to all but the most flexible people. 

In scratching to satisfy the itch, a discolored patch of skin often develops. Though skin changes and itchiness are sometimes a symptom of cancer, notalgia paresthetica (NP) is not. There’s no link between NP and cancer. 

NP is not linked to any diseases. Instead, it’s due to pressure on a nerve root in the spine. This article will explain notalgia paresthetica, its causes, symptoms, diagnosis, treatment, and how it is not a sign or symptom of cancer or linked to cancer.

Person with itch in upper back due to notalgia paresthetica

Peter Dazeley / Getty Images

What Causes Notalgia Paresthetica?

Notalgia paresthetica is most often caused by pressure on the nerve root. It is sometimes called thoracic cutaneous nerve entrapment syndrome.

Nerves come from the spinal cord in the upper back, travel through the back muscles, and make a 90-degree turn toward the skin. The changed sensation (burning, itching, etc.) in the back is due to compression or injury of the nerves of the skin.

Causes can include physical trauma to the back, spinal cord compression, herniated or slipped disks, degenerative diseases of the nerves, infections like shingles, or even a sunburn. NP can sometimes start after excessive, intense exercise that leads to stiff muscles. 

Notalgia Paresthetica Symptoms

The most apparent symptom of notalgia paresthetica is an itching, burning, or tingling sensation between the shoulder blades, usually on either the right or left side of the spine. Scratching can feel good but doesn’t make the itch go away.

In a study of NP patients, in addition to intense itching, 49% felt a burning pain, 31% felt a pricking pain, 16% felt a tingling pain, and 4% felt coldness as their pain sensations.

Scratching or rubbing the itchy skin patch may result in scratch marks, eczema, scarring, or the skin turning lighter or darker. The area may have a changed sensation or be unable to sweat.

When to See a Healthcare Provider

If you have an itch that won’t go away, it’s a good idea to have your skin examined by a healthcare provider. 

Diagnosis

It is unclear how common notalgia paresthetica is, but it's likely underdiagnosed. It can come and go or stay for months or years. It’s most common in women age 54–62.

A healthcare provider can use imaging to check for visible damage to the vertebra, disks, or the nerves in the area. A biopsy (removal of a sample of tissue to analyze in the lab) can rule out other causes of skin changes.

Similar Conditions

Conditions that a healthcare provider may mistake for notalgia paresthetica include fungal infection, eczema (an inflammatory skin condition), parapsoriasis (a skin disorder with a scaly patch), neurodermatitis (a chronic condition of itching and scratching the leads to inflamed skin), and macular amyloidosis (a condition of protein deposits in the skin).

In children, notalgia paresthetica can be a sign of multiple endocrine neoplasia 2A, a genetic disorder linked to growths on the endocrine (hormone-producing) glands.

Treatment

There are no standardized treatments for NP that work every time. But many people find relief by trying different medications. These may include:

Most of these treatments will likely only provide temporary symptom relief. 

Physical therapy focused on back-strengthening and flexibility exercises may also help, including the following:

  • Cross your arms across in front of your chest to grab opposite shoulders and bend forward to stretch the upper back.
  • With your arms at your sides, raise your shoulders and move them forward and backward.
  • Hold your arms straight out to your right and left, then rotate your arms around 360 degrees in your shoulder sockets.
  • Rotate your upper body left and right with your hands on your hips until you feel a stretch, then hold it.
  • Massage the muscles between the shoulder blades on either side of the spine. 

Summary

Notalgia paresthetica is an annoying itch between the shoulder blades caused by injury to the nerves where they leave the spine. It can leave a mark on the back that is darker or lighter than the skin. It is not related to cancers in any way.

Treatments vary but can effectively relieve symptoms, at least for a short time. Physical therapy or surgery may offer more long-lasting relief. 

A Word From Verywell

An itch between the shoulder blades is practically unscratchable without extreme contortions or a back scratcher. See a healthcare professional if the itch persists so you can get to the root cause. Ask about treatments or getting a referral to a physical therapist, if needed. Exercise may help relieve this obnoxious problem.

Frequently Asked Questions

  • What underlying conditions may notalgia paresthetica be a symptom of?

    Most of the time, notalgia paresthetica (NP) is due to pressure on the root of the nerve supplying sensation to the back between the shoulder blades. In children, though, NP may be a sign of the genetic disorder multiple endocrine neoplasia 2A.

  • Does notalgia paresthetica ever go away?

    Notalgia paresthetica can last for months or years. Depending on the cause of your notalgia paresthetica, you may find relief through medications or physical therapy. Surgery may be an option if the cause of the itching is compression of the nerve from problems with the spinal disks.

  • What kind of healthcare provider treats notalgia paresthetica?

    Depending on the cause of your notalgia paresthetica, you may see a dermatologist (specialists in skin conditions), an orthopedic surgeons, radiologists, pain specialists, massage and physical therapists, or acupuncturists.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Osteopathic College of Dermatology. Notalgia paresthetica.

  2. DermNet NZ. Notalgia paraesthetica.

  3. Mülkoğlu C, Nacır B. Notalgia paresthetica: clinical features, radiological evaluation, and a novel therapeutic option. BMC Neurol. 2020;20(1):191. doi:10.1186/s12883-020-01773-6

  4. Ellis C. Notalgia paresthetica: the unreachable itch. Dermatol Pract Concept. 2013;3(1):3-6. doi:10.5826/dpc.0301a02