Eastern Pain Association Annual Meeting 2019 Abstract Session Award Winners

Abstract

Notalgia Paresthetica Successfully Treated with Cervical Epidural Injection and Occipital Nerve Block: A Case Report Fabienne Saint-Preux,1 Justin Mendoza,2 Salvador Portugal1 1Department of Physical Medicine and Rehabilitation, NYU School of Medicine, Manhattan NY, USA; 2Spine Care, Active Orthopedics & Sports Medicine, LLC, Hackensack, NJ, USA Correspondence: Fabienne Saint-Preux Department of Physical Medicine and Rehabilitation, NYU School of Medicine, 240 East 38th Street, 15th floor, Manhattan, NY 10016, USA Tel +1 212 263 6110 Fax +1 212 263 6251 Email fabienne.saint-preux@nyulangone.org Background: Notalgia paresthetica (NP) is a benign relapsing and remitting sensory neuropathic syndrome characterized by localized pruritus usually of the unilateral infrascapular region. Treatment of this associated comorbidity may confer relief and thus increase quality of life. [...]we present a treatment approach with epidural steroid injection (ESI) and adjunctive occipital nerve block. NP is usually localized to the T2–T6 dermatomal distribution and accompanied by localized burning, tenderness, hyperalgesia and dysesthesia resulting in chronic itching and a post-inflammatory hyperpigmented patch that is esthetically distressing.1 The etiology of NP is not fully understood; however, it is widely accepted that the sensory neuropathy is caused by musculoskeletal compression of the cutaneous branches of the dorsal primary rami of thoracic spinal nerves T2–T6.1,2 While NP is associated with symptoms in the T2–T6 dermatomes, it has been associated with cervical spinal disease usually at the C4–C6 level even though the spinal pathology seen on imaging does not correlate with the dermatomal distribution of symptoms.2–6 Current first-line therapies include topical treatments such as lidocaine and capsaicin, conservative management with physical therapy, manual manipulation and/or transcutaneous electrical nerve stimulations (TENS) and medications such as gabapentin with varying and/or temporary success. Topical treatments include capsaicin7,8 tacrolimus9 and anesthetic creams.10 Intralesional treatments include botulinum toxin A,11–13 corticosteroids (triamcinolone)14 and cryolipolysis.15 Oral medications include oxcarbazepine,16 gabapentin17,18 and amitriptyline.19 Other therapies documented include TENS,20 EMS,21 Narrow band UV-B,22 osteopathic manipulation,23 acupuncture,24 exercise25 and physiotherapy.3 Paravertebral nerve blocks,26 intravenous lidocaine infusions27 and surgical decompression28 have also been described.