Altered sensations

Infectious diseases can commonly cause paresthesia when they affect nerves or parts of your brain. Examples of these conditions include:

Paresthesia

Paresthesia is the feeling of tingling, numbness or “pins and needles.” Everyone experiences this feeling at some point in their lives. It’s most often a harmless sign that a limb is “asleep” and you need to shift position or move around. But when it won’t go away or happens often, it can be an important medical condition symptom.

Overview

What is paresthesia?

“Paresthesia” is the technical term for the sensation of tingling, burning, pricking or prickling, skin-crawling, itching, “pins and needles” or numbness on or just underneath your skin. It can affect places on and throughout your body and happens without an outside cause or warning.

Paresthesia (sometimes known as “paresthesia of skin”) is a very common experience. Everyone experiences it at some point, and it can happen for many reasons. Many of the common causes are harmless and are just a reflection of how your body works normally. But in some cases, paresthesia can signal a medical issue.

There are two main forms of paresthesia:

• Transient (temporary): This is the more common type. As the name suggests, it doesn’t last long. An example would be a brief tingling or pins-and-needles feeling in your leg if you sat a certain way too long. Once you extend your leg, the feeling should return to normal.
• Persistent (chronic): This is when paresthesia lingers and doesn’t go away. It’s generally a symptom of issues that may need medical attention. Conditions like carpal tunnel syndrome or cubital tunnel syndrome are relatively minor ways that persistent paresthesia can happen. But you can also have persistent paresthesia from a lack of circulation or nerve damage, both of which are often more serious.

Possible Causes

Paresthesia can be a transient, short-lived concern or it can be persistent and longer-lasting. Persistent causes are more likely to be serious medical conditions or events.

What are the most common causes of paresthesia?

Transient and persistent paresthesias tend to have very different causes.

Transient paresthesia

Transient paresthesia is very common, and it’s usually harmless. It commonly happens because of body positioning that puts pressure on a nerve or limits blood flow (like folding a kink into a hose to keep liquid from flowing through). That can cause the affected body part to “fall asleep” (the technical term for this is “obdormition”). Paresthesia is the feeling of pins and needles that happens when you change position and release the pressure on the nerve or blood vessels in that body part.

Transient paresthesia can also happen if you hit certain body parts against solid objects. For example, bumping something with your elbow can cause a sharp, shock-like feeling of tingling or pain in your ulnar nerve. That’s known as “hitting your funny bone,” as your ulnar nerve is at the lower end of your main upper arm bone, your humerus.

Some other causes of transient paresthesia include:

• Dehydration.
• Formication (a touch-based hallucination that feels like bugs crawling on your skin).
• Hyperventilation.
• Migraines.
• Nerve compression syndromes, such as carpal tunnel syndrome and cubital tunnel syndrome (these can become persistent when they’re moderate or severe).
• Panic attacks.
• Renaud’s syndrome.
• Seizures.
• Whiplash.

Persistent paresthesia

Persistent paresthesia means it’s constant or happens very often. It’s more likely to be from serious causes, which tend to fall into certain categories.

Circulatory causes

One broad category is circulatory causes. A lack of circulation that affects your nerves can disrupt how those nerves carry signals to and from your brain. That can cause paresthesia.

Thoracic outlet syndrome is an example of a circulatory condition that may cause paresthesia. When it’s chronic, Reynaud’s syndrome can also be a form of circulatory-related paresthesia.

Nervous system causes

Neurological causes can involve your brain, spinal cord or nerves anywhere in your body. Some examples of neurological causes include:

• Ataxia-telangiectasia.
• Brain tumors.
• Brain bleeds.
• Charcot-Marie-Tooth disease.
• Head injuries, such as concussions and traumatic brain injuries (TBIs).
• Herniated disks.
• Nerve damage from burns or frostbite.
• Neuralgia (nerve pain) diseases, including occipital neuralgia and trigeminal neuralgia.
• Peripheral neuropathy.
• Pinched nerves or radiculopathy.
• Spinal stenosis.
• Strokes or transient ischemic attacks (TIAs).

Metabolic and endocrine causes

Metabolic and endocrine causes include vitamin deficiencies, conditions that affect certain hormones and more. Examples include:

• Diabetes-related neuropathy (nerve damage).
• Electrolyte imbalances.
• Low blood sugar (hypoglycemia).
• Low parathyroid function (hypoparathyroidism).
• Low thyroid function (hypothyroidism).
• Menopause.
• Vitamin B1 (thiamine) deficiency (also known as beriberi), B5 deficiency, B6 deficiency and B12 deficiency.

Infectious diseases

Infectious diseases can commonly cause paresthesia when they affect nerves or parts of your brain. Examples of these conditions include:

• Any infection that can affect your brain and cause encephalitis or meningitis.
• Guillain-Barré syndrome.
• Hansen’s disease (leprosy).
• Herpes simplex virus.
• Herpes zoster virus (shingles).
• Human immunodeficiency virus (HIV).
• Lyme disease.
• Syphilis.

Autoimmune and inflammatory diseases

Autoimmune conditions are when your immune system attacks parts of your own body. Paresthesia is one of the possible symptoms of an autoimmune condition that attacks your nerves. Inflammatory conditions can also cause swelling and tissue changes that affect nerves. These conditions can include:

• Fibromyalgia.
• Lupus.
• Multiple sclerosis.
• Rheumatoid arthritis.
• Sjögren’s syndrome.
• Transverse myelitis.

Toxic effects

Like many tissues in your body, your nervous system is vulnerable to toxins and poisons. Examples of toxic sources of paresthesia include:

• Arsenic poisoning.
• Carbon monoxide poisoning.
• Chemotherapy.
• Lead poisoning.
• Mercury poisoning.
• Neuropathy from alcohol use disorder.
• Radiation sickness or burns.
• Snake bites.
• Spider bites.
• Scorpion stings.
• Venomous stings/bites from other animals.

Other causes

Other conditions can also cause paresthesia. These can involve organ problems or conditions that don’t fall under the ones mentioned above. A few examples include:

Care and Treatment

How is paresthesia treated?

Some forms of paresthesia — especially transient forms like a limb falling asleep — don’t need treatment. But many other forms of paresthesia may need treatment. The treatments depend on the underlying cause, which means the treatments can vary widely. Your healthcare provider is the best person to tell you about the possible treatments and which they recommend.

What are the possible complications or risks of not treating it?

Most causes of paresthesia need treatment. Many of these conditions, especially several circulation-related and neurological causes, are dangerous or life-threatening without treatment. Other conditions that cause it, while not dangerous, are disruptive and can negatively affect your quality of life without treatment.

You should talk to a healthcare provider if you have paresthesia that affects the same body part on both sides, such as your hands or feet. You should also talk to a provider if you frequently have paresthesia that isn’t posture/body position-related. They can tell you what’s causing your paresthesia and whether or not it needs treatment.

Altered sensations

Altered sensations are fairly common in multiple sclerosis. You might feel pins and needles, burning or crawling sensations, numbness or tightness.

These unusual sensations are a type of nerve (neuropathic) pain. Although the feelings seem to be in the skin, they are actually due to damage caused by MS which disrupts messages passing along nerves in the central nervous system.

What are altered sensations?

Altered sensations can occur in any part of the body, most commonly in the face, body, arms or legs, but may also include the genital area in both men and women. It may occur on just one side of the body or on both sides.

People with MS describe altered sensations as:

• Burning
• Tingling
• Pins and needles
• Crawling
• Numbness
• Prickling
• Sensitive skin
• Wetness
• Stabbing
• Electric shock
• Itching
• Trickling

Although altered sensations in MS may feel itchy, there is no rash or sign of skin irritation unless you’ve been tempted to scratch the itchiness.

Health professionals may ask you whether:

• there is a lack of sensation, as in numbness, or a gain of new sensation, for example a burning feeling
• the altered sensation is painful or not
• the feeling is set off by touch, heat or other triggers or just happens for no obvious reason.

Your MS team may use the following terms in describing your experiences:

• Allodynia: where something like a light touch feels painful, even though it shouldn’t cause pain
• Paraesthesia: an annoying unusual sensation, like tingling or numbness, which may be triggered or just happen spontaneously
• Dysaesthesia: a more intense, sometimes painful, feeling which happens spontaneously
• Sensory symptoms: a more general term for altered sensations.

What causes altered sensations?

Although it feels like something is going on in the skin, the sensations are really due to damage caused by MS to the nerves in the brain and spinal cord. This damage interferes with the normal transmission of messages to the brain. The brain can’t interpret the signals it is receiving as it is outside its experience. To deal with this, it tries to relate it to something the body has experienced before such as itching or burning. Alternatively, the brain may relate it to some other sensation that it can imagine like having insects crawling all over you.

Although the sensation feels like it is in a particular part of your body, such as your fingertips, there is no damage to the tissues in your hand. The only damage is in the nerves which report to your brain about your hand and this is what makes it seem like there is something wrong with your fingertips.

How many people get altered sensations?

In a study of 428 people with MS, 8 in every 100 reported experiencing painful altered sensations (dysaesthesia) in the previous six months. 12 in every 100 people in the same study reported experiencing dysaesthesia at some point in their life. The total number of people who experience altered sensations is likely to be much higher because this study did not count those who had non-painful changes in sensation, such as numbness.

In a study of 224 people with MS, 40% reported experiencing periods of altered sensation lasting from seconds to minutes. The most common description was burning followed by electric shock, insects crawling and then itching. People with early disease and without disability had sensory symptoms just as often as those with disability. This reflects the observation that altered sensation is often one of the first symptoms of multiple sclerosis.

What can I do if I have altered sensations?

Altered sensations may go away completely without treatment or they may return periodically. Persistent symptoms can be difficult to treat. If the altered sensation is having a major impact, your health professionals may suggest drug treatments. Otherwise, managing any trigger factors or changing how you carry out daily tasks may be helpful.

How are altered sensations treated?

If you are concerned about altered sensations, contact your MS nurse or neurologist directly or ask your GP to refer you for assessment.

Drug treatments for altered sensation

Altered sensation is a type of nerve pain so possible drug treatments are the same as for other types of nerve pain. Treatments like Botox or pulsed magnetic field treatment have been shown to improve altered sensations as well as chronic pain, although they are not yet widely used.

Although altered sensation sometimes feel itchy, there is no rash or sign of skin irritation so creams which are typically used to treat skin irritation, such as hydrocortisone, and other skin calming lotions, like calamine, are not helpful.

Occupational therapy

If altered sensations are interfering with your daily activities, an occupational therapist may be able to provide equipment or make suggestions to help. This is particularly true for numbness, for example:

• numbness in the feet can cause difficulty walking as it is hard to feel the floor. This could increase the risk of falls
• numb hands may make it difficult to write, dress or hold a cup, knife or other object safely
• severe numbness in the face can increase the risk of biting the inside of the mouth or tongue whilst eating or chewing
• numbness in any part of the body can increase the risk of burning yourself without realising so it may be important to take care around hot water, fires and other sources of heat.

How can I manage altered sensations myself?

• Triggers. If your altered sensation is triggered, for example, by touch, heat or going out in the wind, you could try avoiding or minimising the trigger. Wearing looser clothing, applying a cool pack or wearing a scarf may be helpful in these cases.
• Change your habits. It can be helpful to change the way that you usually do something. A different style of pen, cup or knife may be easier to hold. A more upright, supportive chair could be helpful. Think carefully about why you do something the way that you do – it can be surprising how often it is just out of habit. Challenge yourself to think creatively so that you come up with new ways of doing things that are easier for you. Ask your family, friends and colleagues to work with you so that they understand how these changes will help you.
• Sexual issues. Numbness or reduced sensation can affect the genital area for both men and women with MS and potentially pleasurable sensations can become uncomfortable. You can read more about sexual issues for men and sexual issues for women with MS.
• Other options. Many of the tips for managing pain yourself also help with altered sensations. They include using heat, cold or relaxation techniques as well as keeping positive and sharing your thoughts about your symptoms and their impact.
• Exercise. A study showed that an 8 week gentle activity programme (yoga or aquatic exercise) significantly improved paresthesia for women with MS, as well as improving their fatigue and mood.

Everyone is different so you may need to try a range of different options before you find what works best for you. You may need to do several at once for the best effect. Some people prefer these approaches to drug treatments as there is less worry about side effects.

Find out more

• What’s with the strange tingling, crawling, burning and prickling feelings? (blog)
• Pain
• Common early symptoms of MS