Treatment of Notalgia Paresthetica Using LLLT/PBMT

Gentle. Drug-Free. Evidence-Informed

Low Level Laser Therapy (LLLT), also known as Photobiomodulation Therapy (PBMT), uses red and near-infrared light applied over targeted areas. In our clinic it is used as part of a GP-led treatment approach for selected presentations, including selected notalgia paresthetica and upper back nerve irritation presentations.

PBMT/LLLT is non-invasive and generally well tolerated. Suitability and response vary, and treatment recommendations depend on the diagnosis, severity, duration of symptoms and individual clinical factors. PBMT/LLLT has been studied for a range of musculoskeletal pain and injury conditions, including some pain and nerve-related presentations. See our references page for supporting literature.

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Key Points

  • Notalgia paresthetica (NP) is a sensory nerve condition that causes itching, burning, tingling or altered sensation, most commonly in the upper back near the shoulder blade region.
  • It is thought to involve irritation or entrapment of cutaneous sensory nerves, often around the thoracic spine or scapular region.
  • Common contributors include degenerative disc disease, spinal or postural factors, local nerve irritation, previous trauma or other causes of nerve sensitivity.
  • Symptoms may include persistent or intermittent itching, burning, pins and needles, tightness or discomfort in the upper back, sometimes radiating to the chest or shoulders.
  • Standard treatments such as antihistamines, topical creams, steroid creams, lignocaine patches, capsaicin, nerve pain medicines, manual therapy, steroid injections or nerve blocks may provide symptom relief for some people, but are not suitable or effective for everyone.
  • LLLT/PBMT is considered for selected notalgia paresthetica presentations where nerve irritation, local inflammatory processes or soft tissue sensitivity are contributing to symptoms.
  • LLLT/PBMT is not a substitute for assessment where symptoms suggest significant spinal compression, progressive neurological signs or another diagnosis requiring specific treatment.
  • Treatment is GP-led by Dr Shikha Parmar and delivered as part of a structured six-week program with individualised advice and review.
Click here for FAQ/Costs

What is Notalgia Paresthetica?

Notalgia paresthetica (NP) is a sensory nerve disorder that causes persistent or recurrent itching, burning or tingling, most commonly in the upper back. The discomfort is usually felt around the shoulder blade region, although symptoms can sometimes radiate towards the chest or shoulder.

The condition is believed to involve irritation or damage to sensory nerves in the upper back. In some people, this may be related to degenerative changes in the thoracic spine, nerve entrapment, posture, previous injury or other local mechanical factors. It is more commonly seen in adults and may be associated with degenerative spinal conditions.

Causes of Notalgia Paresthetica

  • Degenerative disc disease or thoracic spine change causing nerve irritation
  • Spinal stenosis or narrowing around nerve pathways
  • Postural factors that increase local pressure or tension around the upper back
  • Previous trauma, injury or surgery around the shoulder blade region
  • Other conditions that contribute to local nerve irritation or altered sensation

Where LLLT May Help

LLLT/PBMT is considered for selected notalgia paresthetica presentations where symptoms appear related to local nerve irritation, soft tissue sensitivity or inflammatory processes. Treatment is applied externally over targeted regions and aims to help modulate pain, itch and local inflammatory processes without compressing or irritating the affected area.

LLLT/PBMT may be less relevant where symptoms are driven by significant structural compression or another medical condition requiring specific treatment. In those situations, imaging, specialist assessment or other management may be required.

Symptoms of Notalgia Paresthetica

  • Persistent or intermittent itching, tingling or burning in the upper back, often near the shoulder blade
  • Tightness, discomfort or altered sensation in the affected skin or underlying soft tissue
  • Symptoms that worsen with pressure, posture or certain movements such as slouching or reaching
  • Occasional radiation of discomfort towards the chest or shoulder region
  • Skin changes from chronic rubbing or scratching in some people

How is Notalgia Paresthetica Diagnosed?

Diagnosis is based on a clinical assessment. Dr Shikha Parmar will review the location, duration and nature of symptoms and assess the affected area for altered sensation, local tenderness, skin changes and possible musculoskeletal contributors.

Imaging such as X-ray or MRI may be used if symptoms suggest spinal pathology, significant nerve compression or another cause requiring investigation. Additional medical review may be required if symptoms are atypical, progressive or associated with neurological weakness.

Notalgia Paresthetica – Treatment Overview

Low Level Laser Therapy (LLLT), also known as Photobiomodulation Therapy (PBMT), is considered as part of a structured program for selected notalgia paresthetica presentations. It may help modulate local inflammatory processes, oxidative stress, nerve sensitivity and soft tissue irritation without applying mechanical stress to sensitive cutaneous nerves.

Why Consider Low Level Laser Therapy (LLLT)?

Many patients present after limited relief from topical creams, antihistamines, lignocaine patches, capsaicin, nerve pain medicines, massage, injections or postural therapy. These standard treatments may ease symptoms temporarily, but are not suitable or effective for everyone, and symptoms may recur where local nerve irritation remains active.

Why medications and injections may not support long-term recovery. Read more here.

How LLLT Supports Healing

LLLT uses red and near-infrared light and may support:

  • Helping modulate inflammation and oxidative stress
  • Local circulation and oxygen delivery
  • Lymphatic drainage
  • Cellular energy production (ATP)
  • Nerve and soft tissue recovery processes where irritation is present
  • Assisting pain and itch reduction without compressing or irritating the affected upper back region
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Non-Invasive and Supported by Research

PBMT/LLLT is non-invasive and generally well tolerated. It has been studied in a range of musculoskeletal pain and injury conditions, including some pain and nerve-related presentations. Individual responses vary, and outcomes depend on the condition being treated and the stage of recovery. Read more here.

See how LLLT may support the cellular environment involved in tissue recovery here.

Our Treatment Program

All patients are assessed by Dr Shikha Parmar (GP). Treatment is delivered within a structured six-week program, including:

  • Up to 12 LLLT sessions
  • Early progress review after the first 6 treatments
  • Individualised advice and activity modification
  • Guided rehabilitation to support longer-term function

Progress is reviewed during the program. Many patients notice appreciable improvement after the first 6 treatments. If there has not been sufficient improvement by this review point, further treatment may not be recommended.

View the full treatment protocol and expected outcomes here.

Ready to Discuss Your Notalgia Paresthetica Treatment Options?

If you are struggling with persistent itching, burning or tingling from notalgia paresthetica, we invite you to contact our team at Laser Pain Therapy to discuss the suitability of LLLT for your presentation. Treatment suitability and outcomes vary, and assessment is required before recommendations can be made.

Contact us today to arrange your consultation.
📍 Located in Melbourne
📞 (03) 8529 2225 Contact Us

View treatment cost here

Cost / FAQ

At Laser Pain Therapy, we use the terms Low-Level Laser Therapy (LLLT) and Photobiomodulation Therapy (PBMT) interchangeably, as they both refer to the same therapeutic approach. “LLLT” specifically focuses on the use of laser light, while “PBMT” is the broader scientific term describing how light interacts with cells and tissues to influence biological processes involved in tissue recovery.

Both terms refer to light-based therapy that acts on cellular processes involved in local inflammatory modulation, tissue recovery, and healing.

The initial consultation with Dr Shikha Parmar requires up to 60 minutes where your condition is fully assessed along with your medical history. Dr Parmar will take a thorough history of your problem from its onset, through its progression to now. She will review any imaging reports pertaining to your problem, and may recommend further investigations. Dr Parmar will give you a detailed explanation of your problem, and will discuss our holistic approach and management plan including the utilisation of Low Level Laser Therapy (LLLT). If your condition is amenable to LLLT the treatment is commenced at the initial consultation. A medical consultation with Dr Shikha Parmar, GP, is billed and is rebatable through Medicare for patients who hold a Medicare card.


The fee for an initial consultation including Low Level Laser Therapy treatment is $265.00. This includes a Medicare rebate for the GP consultation of $87.10, the out of pocket cost being $177.90.


Pension and Health Care Card holders receive a further reduced fee for the initial consultation of $215.00 only with the out of pocket fee (gap fee) being $127.90.

For each subsequent follow-up consultation involving review of progress, tailored advice and management, and Low Level Laser Therapy treatment, a fee of $135.00 applies. This includes a Medicare rebate for the GP consultation of $45.05, the out of pocket cost (gap fee) being $89.95.

Longer review visits are charged at $215.00 which includes a Medicare rebate $87.10, the out-of-pocket cost being $127.90.

A $15.00 surcharge applies to appointments after 6pm.

Fees may be subject to change and will be confirmed with you at the time of booking. We utilise specialised equipment from Europe and the USA, operated with the assistance of highly trained clinic assistants. No further rebate can be claimed from private health insurance. We are unable to offer bulk billing.

Yes. LLLT/PBMT has been used clinically in Europe for nearly 30 years and has been the subject of substantial published research. The literature includes double-blind studies, laboratory studies, randomised controlled trials, clinical studies and systematic reviews. The strength of evidence varies according to the condition being treated, treatment parameters and clinical context.

Published literature includes papers in journals such as:

  • Nature, Pain, PNS, Blood, BMJ, Spine, Muscle and Nerve, The Lancet, Circulation and BJSM
  • Around 30 LLLT papers published per month
  • Over 4000 laboratory studies and over 400 randomised controlled trials

Over 2,500 clinical studies and published research reports have investigated the use of LLLT/PBMT across a variety of health issues. In the LLLT dental literature alone, involving 370 studies, more than 90% of these studies have reported clinical value for laser therapy.

LLLT has been used in veterinary practices for decades. In recent years, professional sports teams have also begun utilising LLLT/PBMT.

In the last 20 years, 8 systematic reviews have reported findings in favour of LLLT/PBMT in selected clinical contexts, including:

  • American College of Physicians Guidelines include a “strong recommendation” for Low-Level Laser Therapy as a non-invasive treatment for acute, subacute & chronic low back pain. (2017) Click here
  • BMJ LLLT for chronic non-specific low back pain: a systematic review and meta-analysis of randomised controlled trials found “moderate quality of evidence” and “clinically important benefits” in the short term. (2016) Click here
  • BMJ sports medicine journal, systematic review of surgical and conservative interventions for frozen shoulder found “strong evidence” for LLLT. (2010) Click here
  • The BMJ clinical evidence recommendations for tennis elbow 2011 now include LLLT Click here
  • American Physical Therapy Association guidelines recommend LLLT for Achilles tendonitis. (2010) Click here
  • Lancet systematic review: “LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain”. (2009) Click here
  • World Health Organisation Bone and Joint Task Force for neck pain reported Low Level Laser Therapy as “more effective than no treatment, sham, or alternative interventions”. (2008) Click here

Laser Therapy does not heat or cut tissue, unlike high intensity lasers. The question is often asked: “If it’s a laser, aren’t lasers used in surgical operations to cauterise tissue?” The answer is yes. High intensity surgical lasers can cauterise or cut tissue. The lasers used at Laser Pain Therapy are Class 3B low level lasers, a well-researched class in LLLT, designed for low-intensity therapeutic application. Our lasers use light energy to influence cellular processes rather than heat or cut tissue.

Regulatory bodies assess LLLT/PBMT devices according to intended use and device class. Device selection, dosing and clinical supervision are important for appropriate application.

For the past 30 years, Low Level Laser Therapy (LLLT) technology has been formally accepted in many parts of the world such as Canada, USA, Brazil, Europe, Scandinavia, Russia and Japan. Published research and clinical experience over this period support a favourable tolerability profile. LLLT/PBMT is non-invasive and generally well tolerated.

Industry has been using laser diodes for years in applications such as bar code readers, CD players, DVD players, laser printers and pointers. Some bio-stimulation laser devices have been listed as non-significant risk (NSR) devices in specific regulatory contexts.

Hundreds of research studies have investigated Laser Therapy in pain and tissue recovery settings. Laser Therapy is non-invasive and non-thermal. Over 400 LLLT clinical trials (RCTs) and over 2500 laboratory studies have been published. Comparisons with pharmaceutical anti-inflammatory medication depend on the condition being treated, study design and treatment parameters.

LLLT has also been investigated for tissue recovery processes, muscle fatigue, muscle damage and delayed onset muscle soreness, or DOMS.

Most patients tolerate LLLT/PBMT well. Patients may occasionally experience mild discomfort or aching after treatment. This is usually temporary and should settle within 24 to 48 hours.

LLLT/PBMT uses red and near-infrared light and does not use ionising radiation. No mutational effects have been observed from light with wavelengths in the red or infrared range and doses used within LLLT/PBMT in published studies.

Where a patient has known or suspected cancer, this requires medical assessment and appropriate management. LLLT/PBMT at Laser Pain Therapy is not used as a treatment for cancer.

The effects of LLLT/PBMT on cancer cells have been studied in vitro and in animal models, but these findings should not be translated into broad clinical claims about treating cancer or tumour behaviour in people. Treatment decisions are made according to the patient’s clinical context and medical history.

Similarly, laboratory findings involving bacteria or viruses can differ from clinical infection management. This section should not be read as a claim that LLLT/PBMT treats bacterial or viral infection. If infection is suspected, appropriate medical assessment and treatment are required.

Laser Therapy should be avoided in the following instances:

  • Over the womb for women in pregnancy
  • Over a cancerous tumour, primary or secondary (LLLT is not a treatment for these conditions)
  • Direct irradiation of the eyes

At Laser Pain Therapy, we use state-of-the-art, TGA-approved laser devices, applied by highly trained assistants. Our laser devices deliver red and infrared laser energy at selected treatment parameters to support the intended tissue response. With the application of up to 37 diodes (laser lights) across multiple devices, we support time-efficient treatment without compromising dosage or energy delivery. Unlike LED devices, our laser technology provides deeper penetration and more targeted tissue application.

Dr Shikha Parmar, an experienced GP with over 30 years in General Practice and 14 years of expertise in photobiomodulation therapy, leads our clinic, making her one of the most experienced doctors in this field. Treatment at Laser Pain Therapy is medically supervised, ensuring each patient receives a thorough assessment that takes into account not only their presenting condition but also relevant health factors, such as co-morbidities, medications, lifestyle, work, personal activity demands, and nutritional deficiencies. This holistic approach allows us to tailor care with LLLT at the core, supported by personalised advice.

Additionally, our treatment plans are finite, with clear goal-setting and regular progress reviews, supporting each patient to stay on track with their recovery plan and treatment goals.

At Laser Pain Therapy, we use advanced equipment with laser diodes, not LED lights. Unlike LEDs, laser diodes provide more focused light with deeper penetration, making them suitable for targeted musculoskeletal treatment.

Our state-of-the-art equipment features 37 laser diodes, allowing us to efficiently cover a larger surface area. This optimises treatment time and supports targeted energy delivery. Unlike devices that use just 2-4 diodes, our technology allows more time-efficient treatment delivery while maintaining the intended dose and treatment parameters.

The effects of LLLT are accumulative. For many patients undergoing a treatment program, improvements can be sustained when the condition is suitable and the recommended activity advice and rehabilitation plan are followed. Some patients notice early improvement, while others may not notice improvement until after 3 to 5 treatments. Most patients usually require 10-12 treatments.

More severe conditions will usually require more treatments than less severe injuries. Since each person’s condition varies in severity, Dr Parmar will determine after reviewing your condition how laser treatments may benefit you and how many you might require.

Your situation will be assessed after 6 treatments and if there has not been sufficient improvement after 6 to 8 treatments, LLLT will not be continued and alternatives will be considered for your future management.

You will need to follow precautions in order to avoid re-injury or the pain may return. Low Level Laser Therapy may help support tissue recovery processes, but activity modification and rehabilitation remain important for longer-term recovery.

Contact us to book a consultation at our clinic or to learn more about how this form of therapy could help you.

Low level lasers do not generate perceivable heat. Therefore, when the laser contacts the skin, the patient should not experience burning as a result of the laser. Most people feel nothing at all while a few may feel a slight tingling or warmth during the treatment.

No. As Dr Shikha Parmar is a General Practitioner a doctor’s referral is not required.

With our dedicated clinic in Melbourne, contact us at Laser Pain Therapy to discuss how we can assist you

Images and Illustrations Disclaimer

Please note that the images, diagrams, and illustrations used on this website are for demonstration and illustrative purposes only. They are intended to provide a general overview of Photobiomodulation Therapy (PBMT) and Low-Level Laser Therapy (LLLT). The specific methods and equipment we use at Laser Pain Therapy may differ from those depicted. For instance, while some images may show a small laser being applied to the skin, we utilise advanced cluster lasers equipped with multiple diodes, offering broader coverage and targeted application for musculoskeletal conditions. Our treatment protocols are tailored to each patient’s unique needs, using the latest technology and treatment parameters with the aim of optimising treatment response.

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Laser Pain Therapy

South Yarra, Victoria
Suite 8, 200 Toorak Road
(Ground floor from William St)
South Yarra, Vic 3141
Ph: 03 8529 2225
Email us:
info@laserpaintherapy.com.au

Location

TRANSPORT ACCESS:
Train: South Yarra Station, 100m, 1 minute walk
Tram: Route 58, stop no. 127

Easy free street parking:
If driving you will find many free 1P and 2P spots on and around Toorak Rd and William St near the clinic.

 
Call now: 03 8529 2225
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Our Mission

We are dedicated to providing advanced, evidence-informed and affordable medical care for selected musculoskeletal pain and injury presentations. Our approach combines GP-led assessment, individual treatment planning, non-invasive PBMT/LLLT, and practical guidance to support pain relief, recovery, function, and quality of life.

Disclaimer

The contents of this website have not been evaluated by the Australian Government Department of Health. The information of this site is not intended to diagnose, treat, cure or prevent any disease. Individual articles are based upon the opinions of the author, who retains copyright as listed…..Continue Reading

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