Notalgia Paresthetica: An Updated Review of Pathophysiology, Diagnosis, and Treatment Approaches

Notalgia paresthetica (NP) is a chronic sensory neuropathy characterized by localized pruritus and dysesthesia, most commonly affecting the upper back. Despite being a relatively common condition, it remains underdiagnosed and frequently mismanaged. This review covers the pathophysiology, clinical presentation, diagnostic evaluation, and treatment approaches for NP.

Recent studies support a multifactorial pathogenesis for NP, with compression or irritation of the dorsal rami of thoracic spinal nerves playing a central role. Imaging and electromyography have shown variable utility in diagnosis, while histological findings often lack specificity. Although there is no universally effective treatment, advances in topical medications, systemic oral medications, and interventional therapies may be considered. Physical therapy and postural correction remain important non-pharmacologic strategies. NP is a neuropathic condition with evolving diagnostic and therapeutic approaches. Early recognition, multidisciplinary evaluation, and individualized treatment plans are essential for improving patient outcomes. Further research is needed to establish standardized diagnostic criteria and long-term treatment efficacy.