What Causes Paresthesia and How to Treat the 'Pins and Needles' Feeling

Pins and needles in the hands and feet is a common sign of diabetic neuropathy.
Image Credit: dragana991/iStock/GettyImages

Anyone who's ever sat on their foot for too long has likely felt the sensation of paresthesia — the medical term for that tingling, pins-and-needles feeling that can spring up when you accidentally put pressure on a nerve. Once you shift your position, the pesky sensation usually subsides.

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Sometimes, however, that pins-and-needles tingling isn't temporary — rather, paresthesia is a sign of a more permanent condition.

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The good news: The majority of paresthesia cases are mild and easily treated, says Kristin Brown, MD, a neurologist with McGovern Medical School at UTHealth Houston.

Causes of Paresthesia

There are lots of possible culprits behind the pins-and-needles sensation, which can range from the benign (your legs "fell asleep" on the toilet) to the more serious (stroke, Lyme disease). Sometimes, it signals there's a problem with the nerves.

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Because it can be tricky to tell what's causing the problem, though, your first stop will likely be to your primary care doctor, who may also refer you to a neurologist for more testing and a diagnosis.

Some possible causes of pins and needles include the following, according to the Cleveland Clinic and the National Library of Medicine:

Certain Medical Conditions

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Some Infections

  • HIV
  • Lyme disease
  • Shingles
  • Syphilis
  • Tuberculosis

Injuries

  • Animal and insect bites
  • Pinched or injured nerve
  • Ruptured or herniated disc

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Exposure to Toxic Substances

  • Chemotherapy drugs
  • Long-term nerve damage from lead exposure or alcohol or tobacco use
  • Radiation therapy
  • Some street drugs, such as heroin and amphetamines

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Other Causes

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Risk Factors for Paresthesia

People who've experienced sustained pressure on — or trauma to — a nerve can be at increased risk for paresthesia, according to the National Institute of Neurological Disorders and Stroke, as can people with specific diseases. Per the U.S. National Library of Medicine, this can occur if you have:

  • Diabetes
  • An infection, like HIV
  • A suppressed immune system
  • An injury to the spine
  • A diet deficient in B vitamins
  • A condition like carpal tunnel syndrome

Sometimes — but not always — it's possible to narrow down the cause based on where in the body you're feeling that prickling sensation. Below are common causes of paresthesia in your feet, hands, fingers, wrist and more. Keep in mind, though, that these are not the ‌only‌ causes, and the best way to come up with a diagnosis is to work with your doctor.

Pins and Needles in the Feet or Toes

One of the biggest causes of pins and needles in the feet is diabetic neuropathy, or peripheral neuropathy — a type of nerve damage that can arise from uncontrolled diabetes. In fact, the condition may affect up to half of people with diabetes, according to the Mayo Clinic.

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"When people have diabetes and [their blood sugar] is not well controlled, over the years, the nerve fibers start to become damaged," says Absalon Gutierrez, MD, an endocrinologist with McGovern Medical School at UTHealth Houston.

Neuropathy often affects the feet and legs, but it can also occur in the hands and arms, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

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The tingling feeling can eventually progress to something more painful, like a stabbing feeling, and can interfere with your sense of balance.

People with diabetic neuropathy can also lose their ability to feel pain in their feet — and if that occurs, they risk serious injury. "You're not going to know that you stepped on something because you didn't feel the pain, but if you have something in your feet, an infection can develop," Dr. Gutierrez says. Infections, in turn, can result in a need to amputate the foot.

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If you have diabetic neuropathy, you may want to wear appropriate shoes for people with diabetes, which have extra support, decreasing the pressure on your feet. Dr. Gutierrez also recommends checking your feet every day for cuts or ulcers because you may not feel them, and even minor wounds can become dangerously infected.

Other possible causes of peripheral neuropathy include the following, per the Mayo Clinic:

  • Infections, such as HIV, Lyme disease and shingles
  • Autoimmune diseases, such as lupus, rheumatoid arthritis and Sjogren's syndrome
  • Tumors
  • Bone marrow disorders, including lymphoma and bone cancer
  • Kidney or liver disease

What's the Difference Between Paresthesia and Neuropathy?

Paresthesia is the pins-and-needles feeling that is sometimes caused by neuropathy, a form of nerve damage. In this way, paresthesia is a symptom of neuropathy.

Pins and Needles in the Hand, Fingers or Wrist

Diabetic neuropathy can also cause pins-and-needles in the hands, although it's much less likely than paresthesia in the feet, says Dr. Gutierrez. A common cause of paresthesia in the fingers, fingertips, wrist or hand is carpal tunnel syndrome.

If you were to look inside your wrist, you'd see an opening called the carpal tunnel, which has a nerve running through it. When there's pressure on or irritation to this nerve, you can start experiencing numbness or tingling in the fingers (usually the middle and index finger) which may shoot up your wrist or arm, particularly while you're holding something, according to the Mayo Clinic.

People who are pregnant as well as those with certain inflammatory conditions like arthritis or rheumatoid arthritis are at higher risk for carpal tunnel syndrome.

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Carpal tunnel syndrome can also be a symptom of lupus, an autoimmune condition that can damage nerves in the body, according to the Lupus Foundation of America.

If you have tingling or numbness in your hands and fingers after exercise, it could be a sign you need to hydrate better. Dehydration can cause pins and needles by decreasing your body's ability to transmit nerve signals to and from your extremities. In this case, rehydrating will restore your electrolyte balance and solve the problem.

Dehydration may also cause numbness or tingling in the nose or face, but paresthesia here can be a sign of something more serious and warrants a call to your doctor if it doesn't go away quickly.

Pins and Needles in the Legs

Diabetic neuropathy can cause pain and numbness in the legs, as can a pinched nerve in the back. With a pinched back nerve, "some patients feel like they have a funny feeling shooting down their legs," Dr. Brown says.

Another possible culprit here is restless legs syndrome, which typically occurs at night and causes an urge to move the legs along with uncomfortable sensations like tingling, aching or burning.

A tingling feeling could also accompany sciatica. When something puts pressure on the sciatic nerve, such as a herniated disc or additional weight from pregnancy, it can cause pain along the nerve, which runs from the lower back through the hips and butt and down each leg, according to the Mayo Clinic. Sciatica is the name for this pain, so sciatica doesn't cause paresthesia, but it's possible for them to occur together.

Pins and Needles in the Arm

If you have carpal tunnel, you might feel the pins-and-needle sensation in your arm, Dr. Brown says. Or, if you have a pinched nerve in the neck, you may feel the sensation traveling down your arm.

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Diabetic or peripheral neuropathy might be the cause again here, though again, it's more commonly felt in the feet.

Pins and Needles in the Face

Strokes usually cause symptoms on one side of the body, says Dr. Brown, so paresthesia that occurs on one side of the face could be a possible sign of a stroke. (If the pins and needles sensation is occurring all over the body, it may be a sign of something else.)

There's also a condition called diabetic thoracic polyradiculopathy — a condition that causes severe abdominal pain — that can cause pins and needles in the torso, she says, though it also tends to cause sensations of burning and tingling pain, too.

Pins and Needles in the Chest or Back

Many different medical conditions can cause tingling in the chest or back, but a common one is shingles, especially if the feeling is in a relatively small area and only on one side of the body, according to the Mayo Clinic.

Shingles — which is caused by the same virus that causes chickenpox — often comes with a painful rash and fluid-filled blisters, but in some people it may present more as tingling or itching without a rash. Sometimes it can also cause a fever, headache, fatigue and sensitivity to light.

If you suspect you have shingles, call your doctor right away. The condition isn't life-threatening, but untreated infections can lead to a longer illness as well as long-term side effects.

Tip

It's much harder to pinpoint the cause of pins and needles all over your body. If you're tingling all over, see your doctor, who can help you reach a diagnosis.

Diagnosing Paresthesia

If you're experiencing pins and needles, your first stop will likely be to your primary care doctor, who will take your medical history and perform a physical exam (you should see your doctor in person for this reason rather than via telehealth). From there, they'll likely order some tests that will help them narrow down the cause of paresthesia — a blood test if a vitamin deficiency is suspected; a CT or MRI scan to check your spine if an injury is suspected; and so on.

If your doctor isn't able to determine the cause of your paresthesia, or suspects you should be seen by a specialist, you'll be referred to a neurologist. From there, the neurologist may run a test called electromyography (EMG), which checks the body's muscles and nerves.

During an EMG, a doctor will insert a needle electrode into the muscles, which then provides feedback about the electrical activity in those muscles. An EMG can help diagnose the underlying cause of nerve problems.

Treatment of Paresthesia

The treatment for pins and needles will depend on what's causing the tingling in the first place. Sometimes, treating the underlying cause of paresthesia can help resolve the problem, but in other cases, it can become chronic.

For example, diabetic neuropathy isn't reversible, but if it sets in, doctors can treat it with medications like gabapentin, which can help ease nerve pain, Dr. Gutierrez says. Better diabetes management can also help prevent further nerve damage.

If you have carpal tunnel syndrome, and the condition is mild, your doctor may recommend a wrist splint, which can help stabilize the wrist and keep pressure off it, Dr. Brown says. In more serious cases — for example, if a person is experiencing hand weakness — you may be a candidate for surgery, a procedure in which a ligament is cut, releasing the pressure on the nerve, per the Mayo Clinic.

When to See a Doctor

Paresthesia isn't necessarily an emergency, and pins and needles aren't dangerous on their own. But if your paresthesia has come on all of a sudden, or if the pins-and-needle sensation doesn't go away (even if it's better at certain times than others), it's a good idea to call your doctor, says Dr. Brown. You should also call if you have pain that's getting progressively worse.

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references

Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.

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