Paresthesia Explained

Paresthesia
Synonyms:Paraesthesia
Field:Neurology

Paresthesia is an abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) with no apparent physical cause.[1] Paresthesia may be transient or chronic, and may have many possible underlying causes. Paresthesias are usually painless and can occur anywhere on the body, but most commonly occur in the arms and legs.

The most familiar kind of paresthesia is the sensation known as "pins and needles" after having a limb "fall asleep". A less well-known and uncommon paresthesia is formication, the sensation of insects crawling on the skin.

Causes

Transient

Paresthesias of the hands, feet, legs, and arms are common transient symptoms. The briefest electric shock type of paresthesia can be caused by tweaking the ulnar nerve near the elbow; this phenomenon is colloquially known as bumping one's "funny bone". Similar brief shocks can be experienced when any other nerve is tweaked (e.g. a pinched neck nerve may cause a brief shock-like paresthesia toward the scalp). In the older age group, spinal column irregularities may tweak the spinal cord briefly when the head or back is turned, flexed, or extended into brief uncommon positions (Lhermitte's sign).

The most common everyday cause is temporary restriction of nerve impulses to an area of nerves, commonly caused by leaning or resting on parts of the body such as the legs (often followed by a pins and needles tingling sensation). Other causes include conditions such as hyperventilation syndrome and panic attacks. A cold sore outside the mouth (not a canker sore inside the mouth) can be preceded by tingling due to activity of the causative herpes simplex virus. The varicella zoster virus (shingles) also notably may cause recurring pain and tingling in skin or tissue along the distribution path of that nerve (most commonly in the skin, along a dermatome pattern, but sometimes feeling like a headache, chest or abdominal pain, or pelvic pain).

Other common examples occur when sustained pressure has been applied over a nerve, inhibiting or stimulating its function. Removing the pressure typically results in gradual relief of these paresthesias. Most pressure-induced paraesthesia results from awkward posture, such as engaging in cross-legged sitting for prolonged periods of time.[2]

Reactive hyperaemia, which occurs when blood flow is restored after a period of ischemia, may be accompanied by paresthesia, e.g. when patients with Raynaud's disease rewarm after a cold episode.[3]

Cases of paresthesia have also been reported at varying frequencies following anthrax,[4] flu,[5] [6] HPV[7] and COVID-19[8] [9] vaccine intake.

Chronic

Chronic paresthesia (Berger's paresthesia,[10] Sinagesia,[11] or Bernhardt paresthesia)[12] indicates either a problem with the functioning of neurons, or poor circulation.

In older individuals, paresthesia is often the result of poor circulation in the limbs (such as in peripheral vascular disease), 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 or closure of the artery openings, locally and/or 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 or other malnutrition, as well as metabolic disorders like diabetes, hypothyroidism, or hypoparathyroidism. It can also be a symptom of mercury poisoning.

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, 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 may be direct damage to the nerves themselves, i.e., neuropathy, which itself can stem from injury, such as from frostbite; infections such as Lyme disease; or may be indicative of a current neurological disorder. Neuropathy is also a side effect of some chemotherapies, such as in the case of chemotherapy-induced peripheral neuropathy.[13] Benzodiazepine withdrawal may also cause paresthesia, 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 such as multiple sclerosis, complex regional pain syndrome, or lupus erythematosus. The use of fluoroquinolones can also cause paresthesia.[14] Stroke survivors and those with traumatic brain injury (TBI) may experience paresthesia from damage to the central nervous system.

The varicella zoster virus disease (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.[15]

It can also be a sign of hypocalcemia.[16]

Dentistry

Dental paresthesia is loss of sensation caused by maxillary or mandibular anesthetic administration before dental treatment.[17]

Potential causes include trauma introduced to the nerve sheath during administration of the injection, hemorrhage about the sheath, more side-effect-prone types of anesthetic being used, or administration of anesthetic contaminated with alcohol or sterilizing solutions.[18]

Other

Other causes may include:

Drugs

Diagnostics

A nerve conduction study usually provides useful information for making a diagnosis. An MRI or a CT scan is sometimes used to rule out certain causes stemming from central nervous system issues.

Treatment

Medications offered can include the immunosuppressant prednisone, intravenous gamma globulin (IVIG), anticonvulsants such as gabapentin or tiagabine, or antiviral medication, depending on 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. Ketamine has also been successfully used, but is generally not approved by insurance. Careful consideration must be taken to apply only the necessary amount, as excess can contribute to these conditions. Otherwise, these products generally offer extremely effective, but short-lasting relief from these conditions.

Paresthesia caused by stroke may receive some temporary benefit from high doses of baclofen multiple times a day. HIV patients who self-medicate with cannabis report that it reduces their symptoms.[23]

Paresthesia caused by shingles is treated with appropriate antiviral medication.[24]

Etymology

The word paresthesia (; British English paraesthesia; plural paraesthesiae or paraesthesias) comes from the Greek para ("beside", i.e., abnormal) and aisthesia ("sensation").[25]

Bibliography

Notes and References

  1. Web site: 2019-03-27. Paresthesia Information Page. live. 2021-03-12. National Institute of Neurological Disorders and Stroke. 2020-11-11. https://web.archive.org/web/20201111220329/https://www.ninds.nih.gov/Disorders/All-Disorders/Paresthesia-Information-Page.
  2. Web site: Paresthesia National Institute of Neurological Disorders and Stroke . 2022-11-18 . www.ninds.nih.gov . 2022-05-17 . https://web.archive.org/web/20220517010422/https://www.ninds.nih.gov/health-information/disorders/paresthesia . live .
  3. Book: Color atlas of peripheral vascular diseases . 77 . Mosby-Wolfe . 1996 . 978-0-7234-2074-3 . Belch JJ, McCollum PT, Walker WF, Stonebridge PA .
  4. Sever . John L. . Brenner . Alan I. . Gale . Arnold D. . Lyle . Jerry M. . Moulton . Lawrence H. . West . David J. . 2002-05-03 . Safety of anthrax vaccine: a review by the Anthrax Vaccine Expert Committee (AVEC) of adverse events reported to the Vaccine Adverse Event Reporting System (VAERS) . Pharmacoepidemiology and Drug Safety . en . 11 . 3 . 189–202 . 10.1002/pds.712 . 12051118 . 43578539 . 1053-8569 . 2022-11-07 . 2022-11-07 . https://web.archive.org/web/20221107115520/https://onlinelibrary.wiley.com/doi/10.1002/pds.712 . live .
  5. Durrieu . Geneviève . Caillet . Céline . Lacroix . Isabelle . Jacquet . Alexis . Faucher . Angeline . Ouaret . Shéhérazade . Sommet . Agnès . Perault-Pochat . Marie-Christine . Kreft-Jaïs . Carmen . Castot . Anne . Damase-Michel . Christine . Montastruc . Jean-Louis . November–December 2011 . Campagne nationale de vaccination contre la grippe A (H1N1)v : suivi national de pharmacovigilance . Therapies . fr . 66 . 6 . 527–540 . 10.2515/therapie/2011075 . 22186078 . 2022-11-07 . 2023-03-13 . https://web.archive.org/web/20230313195410/https://linkinghub.elsevier.com/retrieve/pii/S0040595716308095 . live .
  6. Serres . Gaston De . Gariépy . Marie-Claude . Coleman . Brenda . Rouleau . Isabelle . McNeil . Shelly . Benoît . Mélanie . McGeer . Allison . Ambrose . Ardith . Needham . Judy . Bergeron . Chantal . Grenier . Cynthia . Sleigh . Kenna . Kallos . Arlene . Ouakki . Manale . Ouhoummane . Najwa . 2012-07-03 . Short and Long-Term Safety of the 2009 AS03-Adjuvanted Pandemic Vaccine . PLOS ONE . en . 7 . 7 . e38563 . 10.1371/journal.pone.0038563 . 1932-6203 . 3389012 . 22802929. 2012PLoSO...738563D . free .
  7. Martínez-Lavín . Manuel . 2015-05-20 . Hypothesis: Human papillomavirus vaccination syndrome—small fiber neuropathy and dysautonomia could be its underlying pathogenesis . Clinical Rheumatology . en . 34 . 7 . 1165–1169 . 10.1007/s10067-015-2969-z . 25990003 . 10315339 . 0770-3198 . 2022-11-07 . 2023-07-02 . https://web.archive.org/web/20230702175715/https://link.springer.com/article/10.1007/s10067-015-2969-z . live .
  8. Yong . Shin-Jie . Halim . Alice . Halim . Michael . Al Mutair . Abbas . Alhumaid . Saad . Al-Sihati . Jehad . Albayat . Hawra . Alsaeed . Mohammed . Garout . Mohammed . Al Azmi . Reyouf . Aldakheel . Noor . Alshukairi . Abeer N. . Al Ali . Hani A. . Almoumen . Adel A. . Rabaan . Ali A. . 2022-07-02 . Rare Adverse Events Associated with BNT162b2 mRNA Vaccine (Pfizer-BioNTech): A Review of Large-Scale, Controlled Surveillance Studies . Vaccines . en . 10 . 7 . 1067 . 10.3390/vaccines10071067 . 2076-393X . 9319660 . 35891231. free .
  9. Allahyari . Fakhri . Molaee . Hamideh . Nejad . Javad Hosseini . 2022-09-12 . Covid-19 vaccines and neurological complications: a systematic review . Zeitschrift für Naturforschung C . 78 . 1–2 . 1–8 . en . 10.1515/znc-2022-0092 . 36087300 . 252181197 . 1865-7125. free .
  10. ICD-10: R20.2
  11. ICD-10: R25.1
  12. ICD-10: G57.1
  13. Web site: Chemotherapy-induced Peripheral Neuropathy. National Cancer Institute. 1 December 2011. dead. https://web.archive.org/web/20111211105234/http://www.cancer.gov/aboutnci/ncicancerbulletin/archive/2010/022310/page6. 11 December 2011.
  14. Web site: FDA Drug Safety Communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection. Food & Drug Administration. 28 May 2016. https://web.archive.org/web/20160528231716/http://www.fda.gov/Drugs/DrugSafety/ucm365050.htm. 28 May 2016. dead.
  15. Book: Marks, Dawn B. . Swanson, Todd . Kim, Sandra I. . Glucksman, Marc . Biochemistry and Molecular biology . . Philadelphia . 2007 . 978-0-7817-8624-9 . registration .
  16. Part 10.1: Life-Threatening Electrolyte Abnormalities . Circulation . 13 December 2005 . 112 . 24_supplement . IV-125 . 10.1161/CIRCULATIONAHA.105.166563 . 79026294 . Symptoms of hypocalcemia usually occur when ionized levels fall to <2.5 mg/dL. Symptoms include paresthesias of the extremities and face, followed by muscle cramps, carpopedal spasm, stridor, tetany, and seizures.. free .
  17. Ahmad. Maha. 2018-02-22. The Anatomical Nature of Dental Paresthesia: A Quick Review. The Open Dentistry Journal. 12. 155–159. 10.2174/1874210601812010155 . free. 1874-2106. 5838625. 29541262.
  18. Garisto. G. Gaffen, A. Lawrence, H. Tenenbaum, H. Haas, D. Occurrence of Paresthesia After Dental Local Anesthetic Administration in the United States. The Journal of the American Dental Association. Jul 2010. 141. 836–844. 7. 20592403. 10.14219/jada.archive.2010.0281. free.
  19. Tihanyi . Benedek T. . Ferentzi . Eszter . Beissner . Florian . Köteles . Ferenc . The neuropsychophysiology of tingling . Consciousness and Cognition . 1 February 2018 . 58 . 97–110 . 10.1016/j.concog.2017.10.015 . 29096941 . 46885551 . 1053-8100.
  20. Vijverberg, H.P., van den Bercken, J. Crit. Rev. Toxicol. (1990) Neurotoxicological effects and the mode of action of pyrethroid insecticides.
  21. Web site: Nitrous Oxide . 2016-03-05 . 2013-05-13 . https://web.archive.org/web/20130513133032/http://www.osha.gov/SLTC/healthguidelines/nitrousoxide/recognition.html#healthhazard . dead .
  22. Orofacial effects of antiretroviral therapies . 11575869 . 2001 . Scully . C. . Diz Dios . P. . Oral Diseases . 7 . 4 . 205–210 . 10.1034/j.1601-0825.2001.70401.x . 2022-06-13 . 2022-06-13 . https://web.archive.org/web/20220613023807/https://pubmed.ncbi.nlm.nih.gov/11575869/ . live .
  23. Woolridge Emily. etal. 2005 . Cannabis use in HIV for pain and other medical symptoms . Journal of Pain and Symptom Management . 29 . 4. 358–367 . 10.1016/j.jpainsymman.2004.07.011. 15857739. free.
  24. 3684190 . 23785227 . 38 . 4 . Presentation and management of herpes zoster (shingles) in the geriatric population . Cohen KR, Salbu RL, Frank J, Israel I . P T . 217–27. 2013 .
  25. Web site: Paresthesia Definition and Origin. 1 August 2015. dictionary.com. Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.
    Most people have experienced temporary paresthesia -- a feeling of "pins and needles" -- at some time in their lives when they have sat with legs crossed for too long, or fallen asleep with an arm crooked under their head. It happens when sustained pressure is placed on a nerve. The feeling quickly goes away once the pressure is relieved.
    Chronic paresthesia is often a symptom of an underlying neurological disease or traumatic nerve damage. Paresthesia can be caused by disorders affecting the central nervous system, such as stroke and transient ischemic attacks (mini-strokes), multiple sclerosis, transverse myelitis, and encephalitis. A tumor or vascular lesion pressed up against the brain or spinal cord can also cause paresthesia. Nerve entrapment syndromes, such as carpal tunnel syndrome, can damage peripheral nerves and cause paresthesia accompanied by pain. Diagnostic evaluation is based on determining the underlying condition causing the paresthetic sensations. An individual's medical history, physical examination, and laboratory tests are essential for the diagnosis. Physicians may order additional tests depending on the suspected cause of the paresthesia.. 12 August 2015. https://web.archive.org/web/20150812080934/http://dictionary.reference.com/browse/paresthesia. live.

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