What are the criticisms of the cervicogenic hypothesis of the pathogenesis of brachioradial pruritus?

Updated: Oct 05, 2020
  • Author: Julianne Mann, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Cervical spinal disease is generally a permanent disorder and, as such, should produce a continuous neuropathic itch, rather than relapsing and remitting symptoms.

Cervical nerve blocks have been reported to be unhelpful. This may suggest that the location of the lesion is either more central (dorsal horn) or more peripheral (sensory nerve endings in the arm).

Degenerative cervical spinal changes are found in 70% of asymptomatic women and 95% of asymptomatic men older than 65 years [30] ; thus, without age-matched controls, implicating cervical spinal disease as the cause of brachioradial pruritus is erroneous. [31] In a large retrospective case series, symptoms of brachioradial pruritus were attributed to cervical spine abnormalities among only 25% of patients. [32]

Conventional electrophysiological testing may not be appropriate in investigating the pathophysiology of brachioradial pruritus because it measures conduction of myelinated fibers, while the afferent nerves that transmit itch are actually unmyelinated. [9]


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