Mechanical Treatment of Common Neuropathic Itch Syndromes: A Retrospective Observational Evaluation of Mckenzie Method for Brachioradial Pruritus and Notalgia Paresthetica

ABSTRACT Background Brachioradial pruritus (BRP) and notalgia paresthetica (NP) are neuropathic itch syndromes that are often challenging to treat, typically managed within a dermatological framework. Emerging evidence suggests a potential link between these conditions and underlying cervical or cervicothoracic pathology. Objectives The current study investigates the application of the Mechanical Diagnosis and Therapy (MDT), also known as the McKenzie Method, in the treatment of BRP and NP, adding a musculoskeletal perspective to the dermatological treatment spectrum. Methods Patients referred for BRP or NP refractory to topic or systemic medical treatment, were educated in line with the standard McKenzie approach to perform repetitive retraction and extension exercises, progressively increasing load from sitting to standing position. Initial itching intensity, scored through the Numeric Rating Scale is compared with the result at the end of treatment, and categorized as complete, partial or no resolution of symptoms. A paired sample two‐sided T‐test compares results per diagnostic group. Results Over a ten‐year period (2014–2023), 30 patients diagnosed with BRP and 30 patients diagnosed with NP by a clinical dermatologist, underwent MDT. Respectively 23 and 28 patients completed their therapy. The treatment's effectiveness was based on patient reported symptom relief, and categorized into complete reduction, partial reduction or no effect. Conclusions Most participants experienced a significant reduction in symptoms, with a notable percentage (BRP: 91.3% and NP: 100%) achieving complete resolution. This suggests MDT's potential as a valuable addition to the treatment regimen for BRP and NP. The study underscores the importance of considering musculoskeletal factors and particularly addressing the underlying cervical or cervicothoracic disease in the treatment of BRP and NP, and proposes MDT as a complementary approach. Future research should focus on larger, randomized controlled trials to validate these findings and explore the long‐term efficacy of MDT, potentially redefining treatment protocols for these conditions.