Saturday, June 23, 2012

The itch you just can't scratch away

My introduction to Brachioradial Pruritis (or BRP) was on July 27, 2011. Mary (name is changed for privacy and confidentiality) came to me as her "last resort" treatment option after battling BRP on and off for 7 years. As a massage therapist, I listened and tried to be compassionate all the while feeling challenged, puzzled and confused. How would massage help with itching? What exactly is BRP? It is an intense itching sensation in the arm usually between shoulder and elbow of either or both arms and is sometimes combined with burning or pain sensations. The most common spot is at the top of the forearm (overlying the brachioradialis muscle) and it can also spread to back and chest. It is a rare disease found most often in women aged 39-72. Rashes, bleeding, bruises, eczema and scarring only occur after chronic scratching. The causes of this mysterious disease are highly debated. The first idea is that it's nerve damage from overexposure to the sun which makes more likely to be a seasonal occurrence. It could also be at least partially due to neuropathy from cervical spine degeneration, osteoarthritis, rib, tumor, and/or nerve compression. Another theory is that BRP is a combination of sun-induced nerve damage and underlying peripheral nerve damage. This theory explains why there are variations in the degree of severity between patients. A complex, almost unknown causation leads to a vague diagnosis and temporary, unsuccessful treatments. Diagnosing Brachioradial Pruritis is based on signs and symptoms as well as the "ice pack sign", application of an ice pack to the affected area decrease the itching. Doctors may also address a history of sun exposure, possible nerve or spinal injury or family history of BRP, MRI, and a dermatological exam of a skin biopsy. Typical treatment options are ice, acupuncture, cervical spine manipulation, cooling lotions and crimes and NSAID's. The most important advice is to avoid sun exposure with clothing which is better than sunscreen. I would like to add to the list therapeutic massage therapy. What I hope to do in the next couple of blog posts is portray a on-going journey for Mary and me as we try to "unpeel" the layers to understanding BRP and work together in hopes of discovering a possible cure for the itch that you just can't scratch away. References Medscape-Brachioradial Pruritus treatment and management Wikipedia, the free encyclopedia Dr. Benabio (online case study)

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