paresthesias

Paresthesias are abnormal sensory experiences described as tingling, prickling, burning, or the sensation of “pins and needles.” They are usually nonpainful but can be uncomfortable and may accompany numbness or reduced sensation. Paresthesias result from irritation or dysfunction of sensory nerves or altered central sensory processing and can be temporary or persistent.

Causes range from benign to serious. Transient paresthesias often arise from prolonged pressure on a limb, poor circulation, or rapid changes in position. Persistent or chronic paresthesias may reflect peripheral neuropathy (for example, due to diabetes, alcoholism, vitamin deficiencies such as B12, or hypothyroidism), nerve compression or radiculopathy (carpal tunnel syndrome, herniated disc), autoimmune or inflammatory neuropathies (Guillain-Barré syndrome, CIDP), metabolic disorders, infections, or exposure to toxins and certain medications (including some chemotherapeutics and antiretrovirals). Central nervous system conditions such as multiple sclerosis or stroke can also produce paresthesias.

Evaluation typically involves a detailed history and neurological examination to localize symptoms and identify red flags (sudden onset with weakness, facial droop, confusion, fever, trauma). Basic laboratory tests may assess glucose, vitamin B12, thyroid function, and inflammatory markers. Neurophysiological studies (nerve conduction studies and electromyography) or imaging may be indicated if an underlying neuropathy or central lesion is suspected.

Management focuses on treating the underlying cause and providing symptomatic relief when needed. Symptomatic options include topical agents, anticonvulsants (e.g., gabapentinoids), certain antidepressants, or other neuropathic pain medications. Prognosis varies with cause; transient paresthesias often resolve, while chronic or progressive etiologies require ongoing management and monitoring.