Thoracic Botox Injections for Refractory Notalgia Paresthetica.

BACKGROUND

Notalgia paresthetica is a chronic neuropathic pruritus at the thoracic interscapular and paravertebral region.

CASE REPORT: A 30-year-old man with a history of diabetes presented to the clinic with left periscapular pain. The patient had chronic, burning, pruritic pain localized to the left mid-thoracic paraspinal region and a well-demarcated hyperpigmentation over the affected area. The patient showed full strength on exam. An MRI scan revealed some degenerative disc disease but no evidence of spinal stenosis. The patient was diagnosed with notalgia paresthetica. He did not respond to conservative management or trigger point injections. After those attempted treatments, he received an injection of botulinum toxin to the left mid-thoracic paraspinals.

RESULTS

The patient experienced a complete resolution of symptoms-including pain and pruritus-for 9 to 10 months.

CONCLUSIONS

Botulinum toxin can be used in refractory cases of notalgia parethetics, as seen in our case, and result in a 10-month resolution of pain. However, evidence for the use of botulinum toxin as a treatment for this condition is limited and inconsistent.