Is Notalgia Paresthetica Linked to Cancer?

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.

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.

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.

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:

• Numbing agents like lidocaine, prilocaine, and pramoxine
• Steroids or anti-inflammatories, either topical or taken by mouth
• Capsaicin (the chemical that makes peppers spicy) creams or patches
• Nerve pain medication and anticonvulsants like Neurontin (gabapentin) or antidepressants like Elavil (amitriptyline)
• Acupuncture
• Mild electrical impulses through a transcutaneous electrical nerve stimulation (TENS) unit
• Spinal nerve block (with a numbing agent and steroid) 
• Manipulation of the spine
• Botox (botulinum toxin)
• Surgery to remove compression of the spine

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.