Document resource
Background and Aims Notalgia paresthetica (NP) is a neuropathic syndrome that involves the unilateral infrascapular region, typically corresponding to the T2-T6 dermatomes. It is classically characterized by localized, episodic pruritus, burning, tingling, and pain, often accompanied by secondary skin lesions resulting from chronic scratching. Although the pathogenesis has not been fully elucidated, it is believed to be the result of spinal nerve impingement or nerve trauma. We aim to present an example of a successful management and highlight the importance of a multidisciplinary approach to it.Methods A 65-year-old female patient, with a medical history of hypothyroidism, nodular thyroid disease and hypertension, started to feel a burning sensation in the left medial infrascapular area by the end of 2022. After dermatology and physical medicine and rehabilitation consultation, a diagnose of NP was done. The initial treatment involved five sessions of cervico-dorsal mesotherapy and application of 5% lidocaine patch, with limited pain control. By the end of 2023 the patient was also receiving physiotherapy twice a week. With no significative improvement, the patient was referred to the chronic pain consult. Since then, was submitted to left dorsal paravertebral block, four capsaicin applications and started 30 mg duloxetine and 50 mg pregabalin twice a day. She was also submitted to four applications of 10 mL subcutaneous ozone.Results Since the referral to chronic pain team and with the implemented multimodal approach, the patient had a significant clinical improvement, with less pain and fewer itching episodes in the first month.Conclusions NP is a clinically poorly recognized syndrome. The lack of studies makes it difficult to optimize the recommendations to treatment. To date, there has been no effective treatment for this condition, decreasing the patients quality of life. This report illustrates a case of treatment success and emphasizes the need for a multidisciplinary and multimodal approach.