Paraesthesia

Paraesthesia is the sensation of tingling, numbness, burning, or “pins and needles” that can affect any part of your body. While everyone experiences these feelings from time to time, understanding when they are harmless and when they require medical attention can help you protect your health.

Table of contents

• What is Paraesthesia?
• Common Sensations and Symptoms
• Types of Paraesthesia
• What Causes Paraesthesia?
• Risk Factors
• Diagnosis
• Treatment Options
• When to Seek Medical Help

What is Paraesthesia?

Paraesthesia is the medical term for unusual skin sensations that occur without any outside cause. Most people describe it as a feeling of tingling, burning, pricking, numbness, or “pins and needles” on or just underneath the skin^[1]. This condition is extremely common, and everyone experiences it at some point in their lives^[2].

The sensation can appear anywhere on the body, but it most commonly affects the hands, arms, legs, and feet^[4]. Less commonly, people may experience paraesthesia in the face, head, or genital area^[7].

The most familiar type of paraesthesia is what happens when a body part “falls asleep.” This occurs when you sit or lie in a position that puts pressure on a nerve for too long^[3]. When you move and release that pressure, you feel the tingling sensation as blood flow and nerve signals return to normal.

Common Sensations and Symptoms

People experience paraesthesia in many different ways. The sensations can feel quite different from one person to another, which can make them difficult to describe^[7]. Common descriptions include:

• Tingling or “pins and needles”
• Numbness or loss of feeling
• Burning sensation
• Prickling or pricking feeling
• Itching
• Sensation of skin crawling
• Feeling of insects crawling on the skin
• Cold or hot sensations
• Weakness in the affected area

These sensations can be constant or they may come and go^[4]. While paraesthesia is usually painless, persistent cases can sometimes cause stabbing pain that leads to clumsiness in the affected area^[9]. When paraesthesia affects the legs and feet, it can make walking difficult.

Types of Paraesthesia

Doctors classify paraesthesia into two main types based on how long it lasts^[1]:

Transient (temporary) paraesthesia is the more common form. As the name suggests, it doesn’t last long. A brief tingling feeling in your leg after sitting cross-legged for too long is an example of transient paraesthesia. Once you change position and extend your leg, the feeling returns to normal^[1].

Persistent (chronic) paraesthesia is when the sensation lingers and doesn’t go away, or when it happens very often. This type is generally a symptom of conditions that may need medical attention^[1]. Conditions like carpal tunnel syndrome (a nerve compression in the wrist) or cubital tunnel syndrome (nerve compression at the elbow) are relatively minor examples of persistent paraesthesia. However, you can also have persistent paraesthesia from a lack of circulation or nerve damage, both of which are often more serious.

What Causes Paraesthesia?

The strange sensations of paraesthesia may feel like they’re coming from your skin, but they’re actually caused by problems with nerves in the brain and spinal cord^[3]. Damage to nerves disrupts how messages travel along the nerve pathways to the brain. When the brain doesn’t know how to interpret these disrupted messages, it tries to relate them to something familiar you’ve experienced before, such as itching, burning, or the feeling of water trickling across your skin.

Common Causes of Transient Paraesthesia

Transient paraesthesia is very common and usually harmless. It typically happens because of body positioning that puts pressure on a nerve or limits blood flow^[1]. Think of it like folding a kink into a garden hose to keep water from flowing through. When you sit with your legs crossed for too long or fall asleep with your arm under your head, you create pressure that causes the affected body part to “fall asleep.” The technical term for this is obdormition.

Other common causes of temporary paraesthesia include^[1]:

• Hitting your “funny bone” (bumping your elbow against something, which affects the ulnar nerve)
• Dehydration
• Hyperventilation
• Panic attacks
• Migraines
• Seizures
• Whiplash
• Raynaud’s syndrome (a condition affecting blood flow to fingers and toes)

Causes of Persistent Paraesthesia

Persistent paraesthesia is more likely to result from serious medical conditions. These causes tend to fall into several categories^[1]:

Circulatory causes: When blood doesn’t flow properly, it can affect how nerves carry signals to and from the brain, causing paraesthesia. Thoracic outlet syndrome is one example of a circulatory condition that may cause these symptoms.

Nervous system causes: Conditions affecting the brain, spinal cord, or nerves throughout the body can cause paraesthesia^[2]. These include:

• Stroke and transient ischemic attacks (mini-strokes)
• Multiple sclerosis
• Brain or spinal cord tumors
• Herniated discs in the spine
• Nerve damage from injuries
• Encephalitis (brain inflammation)
• Transverse myelitis (spinal cord inflammation)

Metabolic and endocrine causes: Hormonal and metabolic problems can also lead to paraesthesia^[5]:

• Diabetes (which can cause nerve damage called diabetic neuropathy)
• Underactive thyroid
• Low blood sugar levels
• Problems with parathyroid function
• Imbalances in electrolytes (minerals in the blood)

Other causes: Additional conditions that can cause paraesthesia include^[4]:

• Vitamin deficiencies, especially vitamins B1, B6, B12, or E
• Fibromyalgia
• Nerve infections
• Compressed or pinched nerves
• Rheumatoid arthritis (which can compress nerves in the joints)
• Side effects from certain medications, including chemotherapy drugs
• Chronic kidney disease

Risk Factors

Certain factors can increase the likelihood of developing paraesthesia^[4]:

• Gender: Women are more likely to develop carpal tunnel syndrome, possibly due to having a narrower nerve canal in the wrist
• Obesity: Excess weight can put pressure on nerves
• Pregnancy: Weight gain and fluid retention during pregnancy can cause swelling and nerve pressure
• Thyroid disease: This can increase risk for nerve compression conditions
• Diabetes: High blood sugar can cause nerve and tissue damage over time
• Rheumatoid arthritis: Inflammation can compress nerves in the joints
• Prolonged bed rest: Lying down for extended periods can cause nerve compression
• Repetitive movements: Repeated motions can lead to nerve compression syndromes

Diagnosis

Finding the cause of paraesthesia can be challenging. Doctors use several approaches to diagnose the underlying condition^[2]:

Your doctor will start by taking a detailed medical history and performing a physical examination. They will ask you to describe the sensations you’re experiencing and may ask you to trace the affected area. They might also test the strength and reflexes in the affected areas.

Depending on what they suspect might be causing your symptoms, your doctor may order additional tests^[2]:

Laboratory tests: Blood tests can check for vitamin deficiencies, diabetes, thyroid problems, and other metabolic conditions that might cause paraesthesia.

Imaging studies: X-rays, CT scans, or MRI scans can help identify herniated discs, tumors, or other structural problems that might be pressing on nerves^[2].

Nerve tests: Electromyography (EMG) measures the electrical activity in muscles, while nerve conduction studies check how well electrical signals travel through your nerves. These tests can help identify nerve damage or compression.

Nerve block: In some cases, doctors may inject a local anesthetic into the affected area. If this relieves the pain, it can help confirm which nerve is causing the problem.

Treatment Options

Treatment for paraesthesia depends on accurately diagnosing and addressing the underlying cause^[2].

Managing Transient Paraesthesia

For temporary paraesthesia caused by pressure on a nerve, simple techniques can help relieve the sensation:

• Change position to remove pressure from the affected area
• Move around to improve blood circulation
• If your hands are affected, try clenching and unclenching your fists
• Gently massage the affected area

Most of the time, the pins and needles feeling is actually a good sign. It indicates that nerves are coming back to life and returning to normal function^[3].

Treating Underlying Conditions

For persistent paraesthesia, treatment focuses on the underlying cause^[2]:

For diabetes: Controlling blood sugar levels through lifestyle changes and medication can help prevent further nerve damage and may improve symptoms.

For vitamin deficiencies: Taking vitamin B12 injections or tablets, or other vitamin supplements as recommended by your doctor, can address deficiencies.

For nerve compression: Physical therapy, wearing splints (such as wrist splints for carpal tunnel syndrome), or in severe cases, surgery to relieve pressure on nerves may be necessary.

For medication-related paraesthesia: If a medication you’re taking causes paraesthesia, your doctor may be able to adjust the dose or switch you to a different medicine.

Managing Nerve Pain

When paraesthesia causes persistent pain, specific medications may help. Common painkillers like paracetamol and ibuprofen often don’t work well for nerve pain^[13]. Instead, doctors may prescribe:

• Antidepressants such as amitriptyline or duloxetine
• Anti-seizure medications such as pregabalin and gabapentin
• Capsaicin cream, made from chili peppers, which can be applied to the skin
• Tramadol, a stronger painkiller, for short-term use in severe cases

These medications are typically started at a low dose and gradually increased. They may cause side effects such as tiredness, dizziness, or a “drunk” feeling when you first start taking them. These effects usually improve after a week or two as your body adjusts^[13].

When to Seek Medical Help

Call emergency services immediately if you experience paraesthesia along with any of these symptoms^[8]:

• Sudden weakness or paralysis
• Confusion
• Difficulty speaking or slurred speech
• Facial drooping
• Sudden, severe headache
• Dizziness
• Loss of bladder or bowel control

These symptoms could indicate a stroke or other serious medical emergency requiring immediate attention.

You should see your doctor if^[1]:

• Paraesthesia persists for a long time
• The sensations happen frequently without an obvious cause
• Symptoms are accompanied by weakness
• The numbness or tingling affects your quality of life or ability to perform daily activities
• You have other symptoms such as muscle spasms, rashes, or increased urination
• You have recently had an injury, especially to your back or neck

Early diagnosis and treatment of underlying conditions can help prevent paraesthesia from worsening and may improve your symptoms^[2]. The outlook depends on the severity of your sensations and any associated conditions, but many causes of paraesthesia can be successfully managed with appropriate treatment.