What That Pins-and-Needles Feeling Really Means

You know that “pins and needles” feeling that comes from falling asleep with your arm tucked under your head? There is a medical term for that: Paresthesia. It happens to most of us at some point, at least temporarily, per the National Institute of Neurological Disorders and Stroke (NINDS). Because it’s caused by inadvertently putting excess pressure on a nerve, everything typically returns to normal when that pressure is relieved by changing positions.

“Paresthesias are abnormal spontaneous sensations that usually manifest as tingling or pins and needles,” says Barbara Giesser, M.D., a neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA.

People with paresthesia may also describe the feeling as:

• Burning

• Cold spots

• Itching

• Numbness

• Pain

• Prickling

• Skin-crawling

• Tingling

When paresthesia becomes especially painful—with burning, stabbing, or lancinating (electric shock-type) symptoms—it’s known as dysesthesia, says Dr. Giesser. “Dysesthesia is any abnormal neuropathic sensation that is painful,” she explains.

It’s most common to feel paresthesia in your hands, arms, legs, or feet, but it can also occur in other areas of the body, says Jacqueline A. Nicholas, M.D., a clinical assistant professor of neurology at the University of Toledo College of Medicine in Toledo, OH.

And sometimes, paresthesia can indicate more than just a foot that’s fallen asleep. Let’s take a look at what else paresthesia may mean, plus tips on how you can find quick relief.

Causes of Paresthesia

While paresthesia is often the simple result of crossing your legs too long or sleeping in a certain way, it may also be a symptom of an underlying medical disorder. “Paresthesia can be a sign of problems in the central nervous system (the brain and spinal cord) or the peripheral nervous system, meaning the nerves that come out of the spinal cord and go to the body and extremities,” says Dr. Giesser. “Different causes can affect one or both of these nervous systems.” Here’s how it breaks down:

Central Nervous System Disorders

Paresthesia that stems from a central nervous system (CNS) disorder can mean that the brain is having a problem interpreting signals from the peripheral nerves. According to the NINDS, CNS disorders that cause paresthesia include:

• Multiple sclerosis (MS): This is an inflammatory autoimmune condition of the central nervous system (CNS).

• Stroke: Stroke refers to damage to the brain caused by a blood clot or brain bleed, or transient ischemic attack (mini-stroke).

• Transverse myelitis: This neurological disorder is caused by inflammation of the spinal cord, similar to MS.

“Numbness due to a CNS disorder might occur when sensation signals are not properly transmitted back to the brain, due to interruption of signaling in the spinal cord or brain,” explains Dr. Giesser.

Are Pins and Needles a Sign of MS?

Paresthesia in various parts of the body is often reported as one of the first symptoms of MS, which affects nearly one million people in the U.S. according to a study in Neurology, although it can happen at any stage of the illness. MS is an autoimmune disease where your immune system mistakes the myelin sheaths that insulate the nerves as something dangerous, attacking and stripping them. Without this covering, nerves can’t properly conduct electrical signals between themselves, leading to a host of potential symptoms that can include paresthesia. A study of 5,311 people with MS, published in the journal Multiple Sclerosis and Related Disorders found that 70% of participants reported experiencing numbness and tingling during a relapse.

People who have MS and certain other neurological diseases may also feel cold spots as a manifestation of paresthesia. “When nerve damage occurs, people can experience a cold sensation on their skin which feels cold to the individual experiencing it, but the skin is not actually cool when touched,” explains Dr. Nicholas. She explains that the sensation can occur as a result of damage to nerve cells: “This may mean that the neural pathways that interpret temperature sensation have been impacted.” It is important to note that MS related paresthesias typically persist over time, at least days, until treated, and may have a consistent pattern where they manifest on the body.

Peripheral Nervous System Problems

Another common cause of paresthesia is peripheral nerve damage, also known as peripheral neuropathy. In this case, the nerves located outside the spinal cord and brain aren't transmitting signals to the brain correctly, resulting in a lack of sensory information, Dr. Nicholas notes.

“Diabetes commonly affects the peripheral nerves and produces peripheral neuropathy,” says Dr. Giesser. With this condition, consistently high blood sugar levels (hyperglycemia) can damage nerves so they may stop sending messages to different parts of your body, explains the Centers for Disease Control and Prevention (CDC). “Nerve damage from high blood sugar is thought to be due to multiple processes, including ischemia or lack of blood flow to the nerve, inflammation, oxidative stress, and other metabolic factors,” adds Dr. Giesser.

In addition to high blood sugar levels, neuropathy may also be caused by vitamin deficiencies, trauma, repetitive movement injuries, rheumatoid arthritis and other autoimmune diseases, kidney disease, liver disease, or hypothyroidism, according to the NINDS.

Nerve Entrapment Syndromes

Nerve entrapment syndromes, such as carpal tunnel syndrome, can damage peripheral nerves and cause paresthesia. Carpal tunnel syndrome occurs when the small passageway formed by the bones in your wrist leading to the lower palm narrows. This may put pressure on the median nerve, which provides feeling to the thumb and some of the fingers. In addition to the pins and needles feeling, you may also have pain or numbness in the hand, weakness when gripping objects and burning or tingling in the fingers (especially the thumb and index and middle fingers). Carpal tunnel syndrome can be the result of frequent repetitive movements, from typing to playing sports.

Radiculopathy is another type of nerve entrapment that occurs when nerve roots branching from the spinal cord become compressed, irritated, or inflamed. It can be caused by a herniated disc pressing on a nerve or a narrowing of the canal that transmits the nerve from the spinal cord to an extremity like your arm or leg.

One common type of radiculopathy is sciatica—pressure on the sciatic nerve that goes from the lower pelvis to the buttocks and legs, typically causing numbness and pain in the lower back or back of the leg. It’s often seen during pregnancy, possibly because of the increase in pregnancy-related weight or because of the shift in the body’s center of gravity.

Getting a Diagnosis

The distribution and location of paresthesia is a clue to the cause and what testing needs to be ordered, says Sabeen Lulu, M.D., director of the Mercy MS Center in Carmichael, CA.

For instance, numbness on both the left side of your face and your right arm and leg can suggest left brainstem involvement, explains Dr. Lulu. If numbness involves both legs, it may indicate a spinal cord problem. And numbness in a small patch of the arm or leg may signal a small superficial nerve involvement.

First, your doctor will take a careful history of your symptoms and perform a physical and neurological exam. They can then carry out the appropriate lab work (blood or urine tests) and may consider imaging, such as a magnetic resonance imaging (MRI) scan, which uses powerful magnets and radio waves to create detailed images of particular parts of the body. Sometimes, an electromyography (EMG) and nerve conduction study (NCS) may also be done to monitor nerve and muscle activity.

Typically, a stroke is diagnosed with a brain MRI, while carpal tunnel syndrome may be diagnosed with a clinical exam or a nerve conduction study, says Dr. Lulu.

Paresthesia Treatments

Treatment for paresthesia will depend on what's causing it. It may be possible to treat the underlying condition to prevent the paresthesia from getting worse.

Some medications can help relieve the symptoms of paresthesia, says Dr. Giesser. For instance, the anticonvulsive medication gabapentin (brand names Neurontin, Gralise, Horizant) is often prescribed to lessen neuropathic pain and discomfort caused by diabetic neuropathy (although it won’t bring back normal sensation). Applying topical capsaicin cream to the area affected by nerve pain can also help, she adds. Capsaicin works by reducing a pain transmitter in the nerves, which in turn reduces the perception of pain.

Pregabalin (Lyrica) and amitriptyline (Elavil) are alternatives to gabapentin used to treat neuropathic pain and discomfort, says Dr. Nicholas. Scientists note that there is little comparative evidence on which medication is the most effective—it may simply be a case of trying one, then switching to another if it doesn’t work.

If paresthesia is severe and interfering with your day-to-day activities (working, typing, walking, or even sleeping) talk to your doctor about which medications may best help improve your symptoms.

Can You Prevent Paresthesia?

If your pins and needles are caused by something as straightforward as the way you’re sleeping or sitting, then preventing the sensation might be as simple as making a body position adjustment.

Not all causes of paresthesia can be prevented, though, but there are things you can do to reduce its occurrence or severity, depending on the underlying issue. For instance, if carpal tunnel syndrome is to blame, using wrist splints at night may alleviate the compression of the nerves of your hands, according to the National Center for Biotechnology Information.

Other potential triggers, like high blood sugar, may be improved through lifestyle changes like diet and exercise. “By trying to eat a well-balanced diet and following up with your primary care physician, you can reduce your risks by monitoring for conditions which could cause paresthesia if not adequately treated,” says Dr. Nicholas.