It is occasionally accompanied by pain, paresthesia (pins and needles), or hyperesthesia (unusual or pathologically increased sensitivity of the skin to sensory stimuli, such as pain, heat, cold, or touch), which results in a well circumscribed hyperpigmentation of a skin patch in the affected area.

[4] The correlation of notalgia paresthetica localization with corresponding degenerative changes in the spine suggests that spinal nerve impingement may be a contributing cause.

According to Plete and Massey, "The posterior rami of spinal nerves arising in T2 through T6 are unique in that they pursue a right-angle course through the multifidus spinae muscle, and this particular circumstance may predispose them to harm from otherwise innocuous insults of a varied nature."

[citation needed] Possible differential diagnoses are:[5] Therapy for notalgia paresthetica is directed at controlling symptoms, as no cure exists for the condition.

[10] One patient has been treated with "paravertebral nerve blocks, with bupivacaine and methylprednisolone acetate injected into the T3–T4 and T5–T6 intervertebral spaces" [11] Hydroxyzine has also been used with considerable success in some cases as long as the pills are used daily.