Abstract
This cross-sectional study assesses the association of neuropathic pruritus with patients’ quality of life.
The negative association of chronic itch with patients’ quality of life (QOL) has been well established in literature, with similar burden of disease and influences on self-esteem as chronic pain.1,2,3 However, most studies to date have focused on chronic inflammatory pruritic conditions. Neuropathic pruritus, including brachioradial pruritus (BRP) and notalgia paresthetica (NP), is unique from other chronically itchy conditions because it is less frequently associated with visible primary dermatologic findings but can be just as bothersome and debilitating.4 In the current study, we aimed to assess the association of neuropathic pruritus with patients’ quality of life.
Methods
A cross-sectional survey was administered to patients with chronic pruritus at the itch centers in the departments of dermatology at the University of Miami and Temple University between 2015 and 2020. Only patients diagnosed with BRP or NP were included in the analyses. Survey data included patient demographics, clinical diagnoses, self-reported itch intensity (numerical rating scale [NRS], 0-10), itch characteristics, and score on the ItchyQoL survey (score range, 1-5).5 The ItchyQoL survey measures 21 items and scores QOL into 3 subcategories: symptoms, functioning, and emotions (eFigure in the Supplement). The institutional review board at the University of Miami granted approval for this study, and written informed consent was obtained from all patients.
Statistical analyses were performed using SPSS statistical software, version 26 (IBM), and included linear regressions for the QOL outcomes, Pearson correlation coefficients for the association between length of itch history and the QOL outcomes, and Spearman correlation coefficient for the association between itch intensity and each of the QOL outcomes. Tests were 2-sided, and the level of significance was P < .05, unless noted as P < .01.
Results
A total of 76 adults (60 [79%] women; age range, 25-95 years) diagnosed with BRP (n = 55) or NP (n = 21) in the absence of other dermatologic diagnoses were included in the analyses. Descriptive statistics are summarized in Table 1. Most notably, patients reported both an average and current mean (SD) NRS itch score of 6.55 (2.78) and an average overall mean (SD) ItchyQoL score of 3.24 (0.93). For reference, a study of 340 patients with atopic dermatitis, a disease with a well-established negative association with patients’ quality of life, found a median NRS itch rating of 6.0 and an average overall ItchyQoL score of 2.9.6 In the present study, of the ItchyQoL subcategories, patients’ emotions were most negatively associated with their condition, although the differences between these 3 subcategories were not statistically significant.
Table 1. Descriptive Statistics of Included Patients (N = 76).
| Category | Patients, No. (%) | Mean (SD) |
|---|---|---|
| Age, y | 76 (100) | 62.05 (12.20) |
| Gender | ||
| Female | 60 (79) | NA |
| Male | 16 (21) | NA |
| Average length of itch history, mo | 72 (95) | 71.61 (74.61) |
| Average current itch intensity (range, 1-10) | 73 (96) | 6.55 (2.78) |
| Frequency of itch, episodes/d | ||
| >10 | 25 (33) | NA |
| 5-10 | 14 (18) | NA |
| 2-4 | 22 (29) | NA |
| ≤1 | 8 (11) | NA |
| Average ItchyQoL score (range, 1-5) | ||
| Overall | 67 (88) | 3.24 (0.93) |
| Symptom | 69 (91) | 3.04 (0.87) |
| Functioning | 74 (97) | 3.06 (1.22) |
| Emotion | 72 (95) | 3.43 (1.12) |
Abbreviation: NA, not applicable.
Itch intensity and average total, symptom, functioning, and emotional QOL scores were all weakly correlated with Pearson r less than 0.80 (0.60, 0.56, 0.46, and 0.51, respectively); however, this may be owing to the reported intensities of patients being skewed, with 57 (75%) patients reporting a current itch score of 5 or greater. The frequency of itch episodes was found to be significantly associated with average QOL when the patient experienced either more than 10 individual episodes per day or 5 to 10 episodes per day, as compared with fewer than 2 episodes per day (t = 3.39, P = .001 and t = 3.59, P = .001, respectively), as well as symptom (t = 2.87, P = .006 and t = 3.57, P = .001, respectively) and emotional (t = 2.98, P = .004 and t = 2.79, P = .007, respectively) QOL (Table 2). Experiencing more than 10 episodes per day was also significantly associated with functioning QOL (t = 2.53, P = .014).
Table 2. ItchyQoL Scores by Category.
| Parameter | Score, mean (SD) (range, 1-5) | |||
|---|---|---|---|---|
| Overall | Symptom | Functioning | Emotional | |
| Frequency of itch, episodes/d | ||||
| >10 | 3.62 (0.83)a | 3.27 (0.92)a | 3.71 (1.00)b | 3.80 (0.90)a |
| 5-10 | 3.42 (1.01)a | 3.35 (1.02)a | 3.35 (1.02) | 3.78 (1.11)a |
| 2-4 | 2.84 (0.84) | 2.72 (0.74) | 2.72 (0.74) | 3.16 (1.01) |
| 1 | 2.93 (0.93) | 2.82 (0.68) | 2.82 (0.68) | 3.07 (1.45) |
| <1 | 1.89 (1.21) | 1.83 (0.60) | 1.95 (1.65) | 1.88 (1.37) |
| Neuropathic itch diagnosis | ||||
| Brachioradial pruritus | 3.44 (0.91)a | 3.32 (0.83)a | 3.35 (1.16)a | 3.62 (1.10)a |
| Notalgia paresthetica | 2.41 (0.81)a | 2.16 (0.61)a | 2.20 (0.95)a | 2.80 (1.02)a |
Statistically significant at P < .01.
Statistically significant at P < .05.
When compared with each other, patients with BRP and patients with NP significantly differed in average overall (t = 3.17, P = .002), symptom (t = 4.74, P < .001), functioning (t = 3.45, P = .001), and emotional (t = 2.68, P = .009) QOL, with patients with BRP having higher scores in all 4 measurements (Table 2). Both gender and age were not found to have significant associations with any of the QOL categories.
Discussion
Findings of this cross-sectional study suggest that neuropathic pruritus is significantly associated with patients’ QOL, with BRP having a greater association with QOL than NP. We believe that this association is, at a minimum, similar to other, more well-studied conditions such as atopic dermatitis. These results are limited by the cross-sectional nature of this study, which prevents determination of causation, as well as by the study’s location at specialized itch clinics, where disease manifestations may tend to be more severe. However, we hope that these findings encourage clinicians to learn more about these understudied yet bothersome and debilitating conditions,4 as well as future research to improve management and treatment of neuropathic pruritus.
eFigure. ItchyQoL—Itching Quality of Life
References
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Associated Data
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Supplementary Materials
eFigure. ItchyQoL—Itching Quality of Life