Transcutaneous electrical nerve stimulation offers partial relief in notalgia paresthetica patients with a relevant spinal pathology
Department of Dermatology, Adnan Menderes University Faculty of Medicine, Aydin, Turkey. The Journal of Dermatology
(Impact Factor: 2.25).
06/2007; 34(5):315-9. DOI: 10.1111/j.1346-8138.2007.00279.x
There is yet no established mode of curative treatment for notalgia paresthetica (NP). We had previously shown a correlation of NP localization with relevant spinal changes which led us to speculate on the possible role of spinal nerve impingement in the pathogenesis of this entity. Based on these findings we aimed to investigate the possible effect of physical therapy in selected cases of NP. Fifteen NP patients with a relevant spinal pathology (four men and 11 women) were included in the study. The mean age was 52.80 +/- 8.83 years (+/- SD; range, 39-73). NP duration was 8.9 +/- 8.13 years (range, 1.5-30). All patients received 10 conventional transcutaneous electrical nerve stimulation (TENS) sessions in the symptomatic area of 20 min duration and high frequency (50-100 Hz). From an initial pruritus score of 10, the mean score by the end of first week was 7.67 +/- 2.02 (range, 5-10) and by the end of second week it was 6.80 +/- 2.73 (range, 4-11). The differences between the pretreatment and post-treatment scores were statistically significant. There was no correlation of therapeutic benefit with age or disease duration. We believe that the partial therapeutic benefit of TENS in NP patients is of importance and further research on the effects of various physical therapeutic modalities would be worthwhile.
Available from: PubMed Central
- "A study by Savk and Savk of 43 patients with NP showed over 60% had radiographic findings of degenerative vertebral changes or herniated discs in areas that corresponded to the dermatomal distribution of their symptoms . Several other studies have similarly shown an association between NP and significant spinal pathology [2,3,9]. "
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ABSTRACT: Notalgia paresthetica (NP) is a very common, under-recognized condition characterized by pruritus in a unilateral, dermatomal distribution in the mid-back. Chronic pruritus is sometimes accompanied by pain, paresthesias, or altered sensation to touch.
To review the current literature with regards to the cause of NP and its most appropriate treatment.
Comprehensive literature review using PubMed to inspect the available data on NP.
The most likely cause of NP is cutaneous nerve damage. Many therapies have been tried in the treatment of NP, mostly in small case studies.
The published cases and studies suggest symptoms of NP are due to a cutaneous sensory neuropathy. Treatments addressing the condition as such are more successful than traditional itch therapies. In many cases, a simple explanation for the persistent pruritus is satisfactory for patients. For very distressing cases, therapy should address the condition as a benign sensory neuropathy. Further studies are needed to evaluate which treatments have the greatest potential for providing symptom relief.
Available from: Sean Mackey
- "It is possible that analgesia from electrical muscle stimulation is a result of transcutaneous electrical nerve stimulation (TENS). A study investigating TENS for relief of NP symptoms where TENS was applied to the symptomatic area medial to the scapula found roughly 30% improvement in pruritus over two weeks , highlighting the need to account for TENS-induced analgesia in any randomized blinded trial by including a TENS control arm. We feel it is unlikely that the analgesia from electrical nerve stimulation provided here was due to a TENS-like effect for three reasons: 1) the area of stimulation on the serratus, on the lateral side of the scapula in the axilla and ventral to the lateral border of the latissimus dorsi (Figure 2), was far removed from the area of pain; 2) pain relief was not apparent during stimulation, relief followed after several days of the treatment, and persisted for several days with only intermittent stimulation and, perhaps most convincingly, 3) several patients required fine adjustment in the placement of the stimulating pads to elicit contraction of the serratus anterior rather than the latissimus dorsi. "
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ABSTRACT: Currently, notalgia paresthetica (NP) is a poorly-understood condition diagnosed on the basis of pruritus, pain, or both, in the area medial to the scapula and lateral to the thoracic spine. It has been proposed that NP is caused by degenerative changes to the T2-T6 vertebrae, genetic disposition, or nerve entrapment of the posterior rami of spinal nerves arising at T2-T6. Despite considerable research, the etiology of NP remains unclear, and a multitude of different treatment modalities have correspondingly met with varying degrees of success. Here we demonstrate that NP can be caused by long thoracic nerve injury leading to serratus anterior dysfunction, and that electrical muscle stimulation (EMS) of the serratus anterior can successfully and conservatively treat NP. In four cases of NP with known injury to the long thoracic nerve we performed transcutaneous EMS to the serratus anterior in an area far lateral to the site of pain and pruritus, resulting in significant and rapid pain relief. These findings are the first to identify long thoracic nerve injury as a cause for notalgia paresthetica and electrical muscle stimulation of the serratus anterior as a possible treatment, and we discuss the implications of these findings on better diagnosing and treating notalgia paresthetica.
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ABSTRACT: Patients may present with a complaint of "itchiness" or an "odd sensation" that can be relieved by manual therapy treatment options, which demonstrates the relevance of transient receptor potential (TRP) channels. There are studies that identify the role of various TRP channels as modulators of the itch sensation; however, discrepancies in the literature exist with respect to the overall neural pathway of the itch sensation, musculoskeletal implications, and decisive therapeutic implications. The purpose of this study was to review the literature and rate the quality of published articles regarding the role of TRP channels in the itch sensation.
A systematic search of relevant literature that was published in English by a peer-reviewed journal between January 2000 and June 2012 was performed in PubMed. Studies that met the predetermined inclusion criteria regarding the relationship between TRP channels and itch were identified and then evaluated for methodological quality by the Downs and Black Quality Index score system and were summarized.
Nine studies were identified that met the inclusion criteria, all of which had fair methodological quality from the perspective of the modified Downs and Black Quality Index. TRPA1, TRPM8, and TRPV1-4 were indicated as key channels responsible for the transmission of the itch sensation. TRPV1 channels convey histamine-dependent itch, and TRPA1 channels convey histamine-independent itch. Temperature, nerve growth factor, and substance-P were also described as important itch modulators. There are similarities between the neural pathways responsible for itch, pain, and temperature, which explain the ability of noxious temperature to suppress the desire to scratch. Although transcutaneous electrical nerve stimulation, innocuous vibration, and cutaneous field stimulation have demonstrated relatively weak attenuation of itch, the use of topical capsaicin, noxious heat, and noxious cold have been demonstrated as effective therapies.
The findings of this review show that studies have assessed the function of TRP channels and itch, rather than identifying the relationship between itch and effective noninvasive treatment options. Therefore, TRP channels could serve as important, complex clinical targets for manual therapists.
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