Paresthesia

Paresthesia is an unusual sensation on the skin, such as tingling, pricking, chilling, burning, or numbness, which occurs without any apparent physical cause. Paresthesia can be transient or chronic and may have various underlying causes. It is commonly experienced in the arms and legs but can occur anywhere on the body.

A well-known form of paresthesia is the "pins and needles" sensation that occurs when a limb "falls asleep." A less familiar but significant type of paresthesia is formication, which is the sensation of insects crawling beneath the skin.

Symptoms of multiple sclerosis

Causes

Transient

Transient paresthesias in the hands, feet, legs, and arms are common, temporary symptoms. Brief, electric shock-like paresthesias can be caused by tweaking a nerve, such as the ulnar nerve near the elbow. In older individuals, spinal column irregularities may briefly affect the spinal cord when the head or back is turned, flexed, or extended into uncommon positions (Lhermitte's sign).

The most common everyday cause is the temporary restriction of nerve impulses to an area of nerves, often caused by leaning or resting on parts of the body, such as the legs. Other causes include conditions like hyperventilation syndrome and panic attacks. Paresthesia can also result from pressure-induced nerve inhibition or stimulation.

Chronic

Chronic paresthesia indicates a problem with neuron functioning or poor circulation. In older individuals, it is often the result of poor circulation in the limbs due to peripheral vascular disease, typically caused by atherosclerosis. Paresthesia can also be a symptom of vitamin deficiency, malnutrition, metabolic disorders like diabetes, hypothyroidism, and hypoparathyroidism, and even mercury poisoning.

Irritation to the nerve can result from inflammation of 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. Paresthesia can also be caused by putting pressure on a nerve for extended periods of time.

Another cause of paresthesia may be direct damage to the nerves themselves, such as neuropathy, which can stem from injury, infection, or a current neurological disorder. Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a transient ischemic attack or autoimmune diseases like multiple sclerosis, Complex Regional Pain Syndrome, or lupus erythematosus. Exposure to fluoroquinolones can also cause paresthesia. Stroke survivors and those with traumatic brain injury (TBI) may experience paresthesia from damage to the central nervous system.

The varicella zoster virus (shingles) can attack nerves, causing numbness instead of the pain commonly associated with shingles.

Acroparesthesia

Acroparesthesia is severe pain in the extremities and may be caused by Fabry disease, a type of sphingolipidosis. It can also be a sign of hypocalcemia.

Dentistry

In dentistry, paresthesia or "persistent anesthesia" is a transient or potentially permanent condition of extended numbness after administering local anesthesia and the injected anesthetic has worn off. Potential causes include trauma to the nerve sheath during the injection, hemorrhage around the sheath, the type of anesthetic used, or the administration of anesthetic potentially contaminated with alcohol or sterilizing solutions.

Other

Other causes of paresthesia may include anticonvulsant drugs, anxiety or panic disorder, Autonomous Sensory Meridian Response (ASMR), benzodiazepine withdrawal syndrome

• Lupus erythematosus
• Lyme disease
• Migraine
• Morton's neuroma
• Multiple sclerosis
• Neuropathy
• Nutritional deficiencies (such as Vitamin B12 deficiency)
• Obdormition
• Peripheral artery disease
• Peripheral neuropathy
• Phantom limb syndrome
• Piriformis syndrome
• Porphyria
• Raynaud's disease
• Restless legs syndrome
• Rheumatoid arthritis
• Sciatica
• Sjögren's syndrome
• Spinal cord injury
• Spinal stenosis
• Spondylosis
• Stroke
• Tarsal tunnel syndrome
• Thoracic outlet syndrome
• Transient ischemic attack
• Ulnar nerve entrapment
• Vasculitis
• Whiplash
• Wilson's disease

Diagnosis

Diagnosing the cause of paresthesia involves identifying the underlying condition responsible for the abnormal sensations. A comprehensive medical history, physical examination, and laboratory tests are crucial for the diagnosis. Physicians may order additional tests depending on the suspected cause of the paresthesia. These tests can include nerve conduction studies, electromyography, blood tests, and imaging studies such as X-rays, CT scans, or MRIs.

Treatment

Treatment for paresthesia primarily depends on addressing the underlying cause. For example, if the paresthesia is caused by a vitamin deficiency, supplementation can help alleviate the symptoms. In cases where the cause is nerve compression, physical therapy, lifestyle modifications, or surgery may be recommended to relieve the pressure on the affected nerve. Medications may be prescribed to manage pain, inflammation, or other symptoms associated with the specific cause of the paresthesia.

In some cases, if the underlying cause cannot be determined or effectively treated, symptomatic management of the paresthesia may be necessary. This can include medications for pain relief, the use of assistive devices, or participation in physical and occupational therapy programs designed to improve function and quality of life.

Prevention

Preventing paresthesia may not always be possible, particularly when it is caused by factors beyond an individual's control, such as neurological disorders or injuries. However, maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding excessive alcohol consumption, can help reduce the risk of developing paresthesia due to nutritional deficiencies or circulatory problems.

In cases where paresthesia is caused by repetitive stress or poor posture, taking breaks from repetitive tasks, using ergonomic equipment, and practicing proper body mechanics can help prevent the development of symptoms. Regular check-ups and managing chronic conditions such as diabetes and vascular disease can also help reduce the risk of paresthesia.

Prognosis

• The prognosis for paresthesia varies widely depending on the underlying cause. In some cases, paresthesia may be temporary and resolve once the underlying issue is addressed. For example, if the paresthesia is caused by nerve compression due to poor posture, making adjustments to posture and ergonomics may alleviate the symptoms.
• In other cases, paresthesia may persist or worsen over time, particularly if the underlying cause is a progressive neurological disorder, such as multiple sclerosis or diabetic neuropathy. For these individuals, the focus may be on managing the symptoms and improving their quality of life through interventions such as physical therapy, occupational therapy, and pain management strategies.

Coping strategies

Living with paresthesia can be challenging, particularly if the symptoms are chronic or interfere with daily activities. Coping strategies that may help individuals with paresthesia include:

• Educating oneself about the condition and its underlying cause to better understand and manage the symptoms.
• Engaging in regular physical activity, which can improve overall health and may help alleviate some symptoms associated with paresthesia.
• Practicing relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, or meditation, which can help manage stress and anxiety that may be associated with chronic paresthesia.
• Seeking support from friends, family, or support groups, which can provide emotional support and practical advice for dealing with the challenges of living with paresthesia.
• Working with healthcare professionals to develop a comprehensive treatment plan that addresses the underlying cause of the paresthesia and helps manage symptoms.

Research

Ongoing research into paresthesia seeks to better understand the underlying causes and mechanisms behind this condition. Scientists are studying the role of various genes, proteins, and signaling pathways in the development of paresthesia, as well as the processes that lead to nerve damage and regeneration. Additionally, researchers are investigating new treatment strategies, including novel medications and therapies that target specific aspects of the underlying conditions responsible for paresthesia. As our understanding of the causes and mechanisms of paresthesia continues to grow, it is hoped that these research efforts will lead to improved diagnostic techniques, more effective treatments, and ultimately, better outcomes for individuals living with this challenging condition.

Prevention

• While not all cases of paresthesia can be prevented, there are steps that individuals can take to reduce their risk of developing the condition or to minimize its severity. Some preventive measures include:
• Maintaining a healthy lifestyle: Eating a balanced diet, getting regular exercise, and managing stress can contribute to overall health and may help prevent some underlying causes of paresthesia, such as diabetes or vitamin deficiencies.
• Proper ergonomics: Ensuring that workstations, seating, and sleeping arrangements support proper posture can help prevent nerve compression, which is a common cause of paresthesia.
• Regular medical check-ups: Routine healthcare visits can help identify and address potential issues before they develop into more serious problems. Discussing any concerns about paresthesia or related symptoms with a healthcare professional is essential for early diagnosis and intervention.
• Avoiding environmental toxins: Exposure to certain chemicals, such as heavy metals or industrial solvents, can contribute to nerve damage and paresthesia. Taking steps to minimize exposure to these toxins is important for overall health and may help prevent the development of paresthesia.
• Managing chronic medical conditions: Proper management of conditions like diabetes, autoimmune diseases, or other disorders that can contribute to nerve damage is crucial for minimizing the risk of developing paresthesia.
• Protecting nerves from injury: Taking precautions during physical activities, such as wearing protective gear during sports or using proper lifting techniques, can help prevent nerve injuries that may lead to paresthesia.
• While these preventive measures can be helpful, it is important to note that not all cases of paresthesia can be prevented. In some cases, the underlying cause may be genetic or related to other factors beyond an individual's control. However, by focusing on maintaining overall health and addressing any potential risk factors, individuals can improve their chances of avoiding or minimizing the impact of paresthesia on their daily lives.

External links

• paresthesia at NINDS

Paresthesia Resources
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Classification	ICD-10: R20.2 ICD-9-CM: 782.0 , 355.1 MeSH: D010292 DiseasesDB: 24182