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Resolution of Notalgia Paresthetica Symptoms following Osteopathic Manipulative Treatment (OMT): A Case Report

Journal: The AAO Journal Date: 2024/06, 34(2):Pages: 18. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/34/2/16/500954/LBORC-NUFA-Poster-Abstracts-2024-Students)

Keywords:

case report [710]
female [607]
notalgia paresthetica [3]
OMT [3752]
osteopathic manipulative treatment [3772]
women [562]

Abstract:

Introduction/Background: Notalgia paresthetica (NP) is characterized by chronic pruritus medial to the scapula with associated sensations of pain, numbness, burning and skin hyperpigmentation resulting from potential T2-T7 thoracic spinal nerve posterior rami compression. Symptomatic NP represents ~8% of chronic pruritus and may persist for months to years. Current treatments including topical capsaicin, gabapentin, lidocaine injections, and physical therapy have not shown long-term relief. Somatic dysfunctions (SD) contributing to NP may be treated with OMT. Case: A 51-year-old female with a history of Hashimoto’s thyroiditis presented with an 8-week history of burning and itching in the left upper back. Symptoms began after ergonomic changes at work which led to poor posture and back strain. Pain was constant, non-radiating, with intermittent 10/10 burning and itching at the medial edge of the left scapula. Ibuprofen did not provide pain relief. Physical examination revealed left-sided cervical lymphadenopathy, bilateral shoulder protraction and mild skin discoloration medial to scapula. Structural exam findings demonstrated key cranial, cervical, and thoracic cage SDs, left scapular restriction, and left posterior ribs 2-7. OMT included cranial OMT, myofascial release, balanced ligamentous tension (BLT), lymphatic drainage techniques and percussion hammer use. Results: Following the first session, the patient’s burning sensation was more localized. After the second OMT session the pain and frequency of burning decreased. Following the third session there was complete symptom resolution. Two months after the last treatment there has been no recurrence of NP symptoms. Discussion: The chronic and recalcitrant nature of NP is associated with frustration, distress, and decreased quality of life. This case highlights the potential for OMT to provide symptomatic relief and even resolve NP. Further research is required to determine OMT efficacy for NP.


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