Peripheral nerve field stimulation for pruritus relief in a patient with notalgia paraesthetica

Abstract

This case study is presented to exemplify the application of peripheral nerve field stimulation in the treatment of recalcitrant notalgia paraesthetica. The patient was a 60-year-old woman with severe and disabling notalgia paraesthetica. The itch persisted despite the use of several medications - topical and oral. Following a successful trial of peripheral nerve field stimulation with a temporary electrode, two subcutaneous electrodes were inserted into the affected area with a battery implanted subcutaneously in her right buttock. The patient was reviewed at 5 months post implantation. She reported a greater than 85% improvement in her itch. She also reported a major improvement in her quality of life, with particular improvement in her ability to sleep through the night. This case illustrates the possible utilization of peripheral nerve field stimulation in the treatment of notalgia paraesthetica, which is a common yet poorly understood and treated condition. Replication and controlled studies are required to determine the general applicability of this approach.

Electrical neurostimulation for the treatment of chronic pruritus: A systematic review

“…We identified one case report applying PNFS to a 60‐year‐old woman with intractable notalgia paresthetica. 57 Postimplantation of the subcutaneous PNFS electrode, the patient described an 85% reduction of itch intensity, compared to baseline. This effect was maintained for at least 5 months.…”

“…Of these 37 reports, 13 were excluded because they were duplicates or because there was no full‐text version available. 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 After full‐text screening of the remaining 24 reports, another five were excluded because they concerned experimentally or otherwise induced itch, 35 , 36 , 37 because they primarily concerned pain, 38 or because they were a letter to the editor 39 (Figure 1 ).…”

“…Nineteen studies were included: two randomized controlled trials (RCT), 40 , 41 ten uncontrolled trials, 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 one case series 52 and six case reports. 53 , 54 , 55 , 56 , 57 , 58 …”

“… 41 , 50 One was a randomized controlled trial that compared the effect of CFS with the effect of TENS. 41 Furthermore, we identified studies that evaluated the effect of painscrambler therapy, 44 tDCS 55 and PNFS 57 (Table 1 ).…”

“…Nineteen studies were included: two randomized controlled trials (RCT), 40,41 ten uncontrolled trials, [42][43][44][45][46][47][48][49][50][51] one case series 52 and six case reports. [53][54][55][56][57][58] All studies reported a positive effect of at least one modality of electrical neurostimulation on itch. There was, however, large heterogeneity in methodological set-up and how the effect on pruritus of various aetiologies was measured.…”