Paresthesia

This article is about the physical condition. For other uses, see Pins and Needles (disambiguation).

Paresthesia

ICD-10	R20.2
ICD-9	782.0, 355.1
MeSH	D010292

Paresthesia (/ˌpærɨsˈθiːziə/ or /ˌpærɨsˈθiːʒə/), spelled "paraesthesia" in British English, is a sensation of tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb "falling asleep". The manifestation of paresthesia may be transient or chronic.

Etymology

Greek para ("beside", i.e., abnormal) and aisthesia ("sensation").

Cause

Transient

Paresthesias of the hands and feet are common, transient symptoms of the related conditions of hyperventilation syndrome, often open mouth, and panic attacks.

Other common examples occur when sustained pressure has been applied over a nerve, inhibiting/stimulating its function. Removing the pressure will typically result in gradual relief of these paresthesias, often described as a "pins and needles" feeling.^[1]

Chronic

Chronic paresthesia indicates a problem with the functioning of neurons.

In older individuals, paresthesia is often the result of poor circulation in the limbs (such as in peripheral vascular disease, also referred to by physicians as PVD or PAD), most often caused by atherosclerosis, the build up of plaque within artery walls, over decades, with eventual plaque ruptures, internal clots over the ruptures and subsequent clot healing but leaving behind narrowing of the artery openings or closure, both locally and in downstream smaller branches. Without a proper supply of blood and nutrients, nerve cells can no longer adequately send signals to the brain. Because of this, paresthesia can also be a symptom of vitamin deficiency and malnutrition, as well as metabolic disorders like diabetes, hypothyroidism, and hypoparathyroidism.

Irritation to the nerve can also come from inflammation to the tissue. Joint conditions such as rheumatoid arthritis, psoriatic arthritis, and carpal tunnel syndrome are common sources of paresthesia. Nerves below the head may be compressed where chronic neck and spine problems exist and can be caused by, among other things, muscle cramps that may be a result of clinical anxiety or excessive mental stress,^{[citation needed]} bone disease, poor posture, unsafe heavy-lifting practices or physical trauma such as whiplash. Paresthesia can also be caused simply by putting pressure on a nerve by applying weight (or pressure) to the limb for extended periods of time.

Another cause of paresthesia, however, may be direct damage to the nerves themselves, i.e., neuropathy, which itself can stem from injury or infection such as frostbite or Lyme disease, or which may be indicative of a current neurological disorder. Benzodiazepine withdrawal may also cause it as the drug removal leaves the GABA receptors stripped bare and possibly malformed. Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a transient ischemic attack, or autoimmune diseases like multiple sclerosis or lupus erythematosus.

The herpes zoster virus (shingles) can attack nerves causing numbness instead of pain commonly associated with shingles. A diagnostic evaluation by a medical doctor is necessary to rule these out.^{[clarification needed]}

Demyelinating diseases may also cause cross-talk between adjacent axons and lead to parasthesia. During impulse conduction some aberrant current that escaped a demyelinated axon can circulate in the exterior and depolarize an adjacent demyelinated, hyperexcitable axon. This can generate impulses conducted in both directions along this axon since no part of the axon is in a refractory state. This becomes very serious in conditions such as multiple sclerosis and Guillain–Barré syndrome.

Acroparesthesia

Acroparesthesia is severe pain in the extremities, and may be caused by Fabry disease, a type of sphingolipidosis.^[2]

Other

Other causes may include:

anticonvulsant pharmaceutical drugs, such as topiramate, sultiame, and acetazolamide anxiety and/or panic disorder[3] carpal tunnel syndrome chiari 1 malformation complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD) beta-alanine beta blocker celiac disease decompression sickness dehydration dextromethorphan (recreational use) Fabry disease fibromyalgia Guillain–Barré syndrome (GBS) heavy metals hydroxy alpha sanshool, a component of Sichuan peppers hyperglycemia (high blood sugar) hyperkalemia hyperventilation hypoglycemia (low blood sugar) Hypomagnesemia, often as a result of long term Proton-pump inhibitor use hypothyroidism immunodeficiency, such as chronic inflammatory demyelinating polyneuropathy (CIDP)

intravenous administrating of strong pharmaceutical drugs acting on the central nervous system (CNS), mainly opioids, opiates, narcotics; especially in non-medical use (drug abuse) lidocaine poisoning Lomotil menopause mercury poisoning migraines multiple sclerosis nitrous oxide, long-term exposure [4] obdormition pyrethrum and pyrethroid (pesticide) rabies radiation poisoning sarcoidosis spinal disc herniation or injury stinging nettles syringomyelia transverse myelitis vitamin B5 deficiency vitamin B12 deficiency withdrawal from certain selective serotonin reuptake inhibitors (or serotonin-specific reuptake inhibitors) (SSRIs), such as paroxetine and venlafaxine

Diagnostic approach

The nerve conduction study usually provides useful information for making diagnosis. A CT scan is sometimes used to rule out some causes from the central nervous system.

Treatment

Medications offered can include the immunosuppressant prednisone, intravenous gamma globulin (IVIG), anticonvulsants such as gabapentin or Gabitril and antiviral medication, among others, according to the underlying cause.

In addition to treatment of the underlying disorder, palliative care can include the use of topical numbing creams, such as lidocaine or prilocaine. Care must be take to apply only the necessary amount, as excess can contribute to the condition. Otherwise, these products offer extremely effective, but short-lasting, relief from the condition.

In some cases, rocking the head from side to side will painlessly remove the "pins and needles" sensation in less than a minute. A tingly hand or arm is often the result of compression in the bundle of nerves in the neck. Loosening the neck muscles releases the pressure. Compressed nerves lower in the body govern the feet, and standing up and walking around will typically relieve the sensation. An arm that has "fallen asleep" may also be "awoken" more quickly by clenching and unclenching the fist several times; the muscle movement increases blood flow and helps the limb return to normal. However, in some cases, this clenching action simply exacerbates the discomfort. More rapid relief can sometimes be obtained by gently and systematically massaging the affected area of the body.

Paresthesia caused by shingles is treated with appropriate antiviral medication.

References

1. ^ Paresthesia Information Page: National Institute of Neurological Disorders and Stroke. (NINDS)
2. ^ Marks, Dawn B.;Swanson, Todd; Kim, Sandra I.;Glucksman, Marc (2007). Biochemistry and Molecular biology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0-7817-8624-X. 
3. ^ Ietsugu, T; Sukigara, M, Furukawa, TA (Dec 2007). "Evaluation of diagnostic criteria for panic attack using item response theory: findings from the National Comorbidity Survey in USA.". Journal of affective disorders 104 (1-3): 197–201. PMID 17434598. http://www.ncbi.nlm.nih.gov/pubmed/17434598. 
4. ^ Nitrous Oxide

• [Clinical and neurological abnormalities in adult celiac disease, G. Cicarelli • G. Della Rocca • M. Amboni • C. Ciacci • G. Mazzacca • A. Filla • P. Barone,

Neurol Sci (2003) 24:311–317 DOI 10.1007/s10072-003-0181-4]

External links

• paresthesia at NINDS
• What makes your arms, legs and feet fall asleep?