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Paresthesia is a sensation of the skin that may feel like numbness ( hypoesthesia), tingling, pricking, chilling, or burning. It can be temporary or chronic and has many possible underlying causes. Paresthesia is usually painless and can occur anywhere on the body, but most commonly 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" ( obdormition). A less common kind is formication, the sensation of insects crawling on the skin.
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 . 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.
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. (1996). 9780723420743, Mosby-Wolfe. ISBN 9780723420743
Cases of paresthesia have also been reported at varying frequencies following Anthrax vaccines, flu, HPV vaccine and COVID-19 vaccine intake. Benzodiazepine withdrawal may also cause paresthesia, as the drug removal leaves the GABA receptors stripped bare and possibly malformed.
In the elderly, 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 stenosis 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.
Another cause of paresthesia may be direct damage to the nerves themselves, i.e., neuropathy, which itself can stem from nerve 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. 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. Stroke survivors and those with traumatic brain injury (TBI) may experience paresthesia from damage to the central nervous system.
It can also be a sign of hypocalcemia.
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.
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.
Paresthesia caused by shingles is treated with appropriate antiviral medication.
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