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Notalgia Paresthetica, Pain, Bulging disc related?

I was injured in a car accident almost 2 years ago while 4 months pregnant. I have had horrible back pain ever since and all my DRS are acting like they don't know why.

After being seen by every specialist, X-rays, MRI of the spine, P.T, Chiropractic, Acupuncture, Massage,  etc you name it. I ended up at a random DRS appointment for some skin problems. I asked the dermatologist if she seen anything on this spot on my back (left shoulder blade) as I had a constant horrible itch and would itch so bad I would bleed.... she than started asking me questions about had I been injured on my back or neck and I said YES!

Without any answers as to why I am in constant pain and no anti- inflammatory drugs or typical pain meds help either. She than said you have N.P. So again I go through all these DRS appointments and have been given Nortriptylin for my pain and surprising I now have relief. My question is N.P is recognized as a medical condition however they state they don't know enough about it and there hasn't been enough research and ones quality of life will worsen with NP which mine is and has. Everything I do to treat is brings minimal relief short lived and the meds I can only take at night. My dermatologist suggested a MRI in my neck as that is where injury shows for N.P so we did it and walla I have a bulging disc at c-5/c-6 and also c3/c4 has something I don't understand going on. If anyone out there can help me understand all of this and if there is anything I can do to help my condition/pain. See MRI results below...

39-year-old woman with left scapular paresthesia. History of MVA.

COMPARISON:
None available


Technique: Using a 1.5 Tesla closed magnet, multisequence
multiplanar MRI was performed without contrast per regional
protocol. Institution-specific screening and safety protocol
observed. Overall image quality is satisfactory.

** FINDINGS **:
Alignment is anatomic in the sagittal plane on this nonweight
bearing exam. Vertebral body heights are preserved without
fracture or osteonecrosis. No suspicious marrow signal intensity
is identified. There is no tonsillar ectopia. The flow voids of
the vertebral arteries are preserved.

The cervical cord is normal in morphology and signal intensity.

The atlanto-occipital relationship is preserved.

Axial interrogation through the cervical spine demonstrates the
following:

C2-C3: Disk height is maintained with preservation of posterior
disc contour. There is no central stenosis or neural foraminal
narrowing. The facet joints are preserved.

C3-C4: Disc height is maintained with a minimal posterior central
disc osteophyte complex without central stenosis. No neural
foraminal narrowing is identified. The facet joints are maintained.

C4-C5: Disk height is maintained with preservation of posterior
disc contour. There is no central stenosis or neural foraminal
narrowing. The facet joints are preserved.

C5-C6: Disk height is maintained with a broad-based posterior disc
osteophyte complex which partially effaces the ventral CSF space
and contributes to mild central stenosis. Uncovertebral osteophyte
formation results in mild left neural foraminal narrowing. The
right neural foramen is not narrowed. The facet joints are
maintained.

C6-C7: Disk height is maintained with preservation of posterior
disc contour. There is no central stenosis or neural foraminal
narrowing. The facet joints are preserved.

C7-T1: Disk height is maintained with preservation of posterior
disc contour. There is no central stenosis or neural foraminal
narrowing. The facet joints are preserved.

Evaluation of the paraspinal soft tissues demonstrates no
paraspinal fluid collection. A 11 mm AP by 9 mm transverse focus
of low signal intensity along the anterior left floor of mouth may
represent a calculus within the salivary duct or focal
mineralization.

** IMPRESSION **:
1. Mild discogenic disease of the cervical spine, most prominent
at C5-C6 with mild central stenosis and mild left neural foraminal
narrowing.

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Avatar universal
NP is variously called rare as well as common. Its commonly missed because itch can be transient even if later it becomes constant or more severe. Usually its a dermatologist who makes the diagnosis since it is the skin discolouration that prompts care-seeking. But you are right - injury can often precede such a condition. Even now it is unclear exactly where the nerve damage is likely to be. It can be anywhere along its pathway as it exits the spine and provides innervation to that patch of skin mid-line to the shoulder blade. The nerve roots naturally glide in and out between adjacent tissues with natural movement, and the nerve also does this between the layers of connective tissue or muscles it passes before it reaches the nerve-endings in the skin - branching as it does. The posterior ramus of the nerve root in the thoracic region takes a few sharp bends and can be irritated or compressed along its path. These irritating forces are exacerbated by arthritic spurs, increased thoracic curvature, tight spinal muscles in addition to local inflammation. At this stage I don't think anyone knows why this becomes an itch in this region rather than pain or numbness as it might in other peripheral neuropathies. Itch nerves are rare, but when irritated they appear to recruit adjacent pain fibres to amplify the itch sensation. There are many other causes of itch which can influence the threshold of itch - so that many treatments only work partially - exactly as you have reported.

Whether the disc problem in your neck is involved in the thoracic area itch is unclear. I say this because nerve compression in the neck usually affects nerves into the arm and shoulders- rather than the midback. Usually the midback itch is from compression of thoracic spine rami. Cervical disc irritation MIGHT compound this midback pain because nerves innervating the cervical disc itself can refer to the mid-back region, Again no explanation can be given regarding why its itch rather than other symptoms.
Helpful - 0
7721494 tn?1431627964
I haven't spoken with anyone having a diagnosis of notalgia paresthetica in many years, although I understand it is common enough in people aged 40 - 80.

Usually a dermatologist discovers and makes the diagnosis.

You're right -- we don't know much about it, other than it seems to be a kind of neuropathy. The reasons behind notalgia p. are unknown.

And with your cervical MRI report, I wouldn't consider seeing a surgeon. Surgery could do more harm than good for now. Your c. spine disease is mild, and you may get some relief from PT, then again with your Dx, you may not.

There is some success in treatment using TENS. Ask your doctor about a trial with a TENS machine. If TENS works for your pain, what a simple solution!

Nortriptyline is what's called a tricyclic antidepressant (TCA), and chemically, it is a drug similar to an antihistamine (that's how it was discovered -- looking for a better cold medicine.)  TCAs are effective against certain kinds of pain. If you have limited side effects, then use it. It might help with sleep, also.

Best wishes.
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