What are paresthesias? In medicine, paresthesia (in English ‘paresthesia’) refers to a condition characterised by an altered perception of sensitivity to various sensory stimuli (thermal, tactile, painful, vibratory) both in their onset, duration and dislocation

The term ‘paresthesia’ also refers to a subjective disturbance of sensitivity consisting of the onset of an elementary sensation (tingling, tingling, tickling, itching, pinprick, etc.) in the absence of specific stimulation.

A ‘normal’ tingling sensation tends to occur when standing or sitting too long, or when wearing shoes that are too tight and excessively high heels: usually this type of tingling disappears within a few minutes by changing position or type of shoe.

Causes and risk factors for paresthesias

There are many conditions and pathologies that can cause paresthesia, from myelopathies and radiculopathies to poor blood circulation.

Usually one or more factors that interfere with the functioning of the nervous system (both central and peripheral) and/or the vascular system (both arterial and venous) are at the root of paresthesia.

When paresthesia is characterised by transient tingling in the feet, it may be due to a pinching of nerves: this occurs if standing or sitting for a long time or wearing shoes that are too tight and high heels.

Some diseases and conditions that can cause or promote paresthesias are:

• claudication intermittens;
• cerebral stroke;
• benign cramps and fasciculations syndrome;
• salivary gland tumours;
• acromegaly;
• chronic anxiety and stress;
• myocardial infarction;
• cervical spondylosis;
• lumbar spondylosis;
• arthrosis;
• various types of disc disease, such as herniated discs;
• spondylolisthesis;
• syringomyelia (from Chiari malformation, trauma, tumour or scoliosis/kyphosis);
• abnormal bone masses as from Paget’s disease or bone tumours/metastases;
• spinal tumours;
• congenital malformations of the spine;
• infections;
• chronic fatigue syndrome;
• vertebral fractures;
• acquired neuromyotonia or Isaacs syndrome;
• chronically incorrect posture;
• holding a body position for too long (e.g. standing or sitting);
• trauma to the spine (from traffic accidents, sports, etc.);
• trauma of various kinds;
• wearing tight and/or high-heeled shoes;
• stiff man syndrome;
• amyloidosis;
• familiarity;
• atherosclerosis;
• thrombosis;
• embolism;
• ischaemia;
• diabetic foot;
• polycythaemia vera;
• poliomyelitis;
• rabies;
• vasculopathies;
• coagulopathies;
• carpal tunnel syndrome;
• Sjögren’s syndrome;
• fibromyalgia;
• burns;
• poor venous circulation;
• varicose veins;
• panic attacks;
• headache;
• diabetes;
• dyslipidemia;
• breast cancer;
• skin diseases;
• ebola virus;
• liver or kidney inflammation;
• Raynaud’s phenomenon;
• hyperthyroidism;
• multiple sclerosis;
• abuse of alcohol, tobacco or other substances;
• side effect of a medicine being taken;
• migraine headaches;
• chilblains;
• Herpes zoster;
• ophthalmic herpes zoster;
• inflammation of the trigeminal nerve;
• Paget’s disease.

Symptoms and signs associated with paresthesia

Depending on the underlying pathology causing it, paresthesia may be associated with numerous other symptoms, such as

• pain at the site of onset of cord and/or spinal nerve compression, e.g. neck, chest, back, lower back and/or upper or lower limbs, in some cases radiating to the feet or hands
• feeling of stiffness in the neck, back and/or upper or lower limbs;
• urinary disorders: e.g. urinary incontinence and difficulty urinating
• bowel disorders: e.g. faecal incontinence and constipation;
• sexual disorders: difficulty maintaining an erection and/or anorgasmia;
• flu-like symptoms such as fever, headache, nausea, vomiting, widespread tiredness, loss of appetite, general malaise (especially in the case of inflammation/infection of the spinal cord)
• claudicatio intermittens;
• asthenia (general lack of strength)
• easy fatigability;
• myoclonus;
• drowsiness;
• muscle spasms;
• loss of reflexes;
• loss of strength in the upper and/or lower limbs;
• motor difficulties;
• muscle fasciculations;
• paralysis of the upper and/or lower limbs;
• loss of skin sensitivity;
• soreness;
• numbness in the face;
• unsteadiness of posture sometimes with loss of balance;
• muscle atrophy.

Diagnosis

The investigations useful in diagnosing the underlying cause of paresthesia vary depending on the pathology or condition that the doctor comes to suspect through the anamnesis (collection of all data relating to the patient and his history) and the objective examination (the actual examination).

In general, examinations that could be useful in diagnosing the cause of paresthesia are:

• blood tests;
• laboratory tests;
• magnetic resonance imaging;
• computed tomography (CT);
• radiography;
• myelography;
• electrocardiogram;
• ultrasound with colordoppler
• biopsies;
• postural analysis;
• vestibular examination;
• electromyography;
• electroencephalogram;
• lumbar puncture.

IMPORTANT: Not all the examinations listed are always necessary.

The diagnosis (and treatment) of a condition that causes paresthesia may require the intervention of various professionals, including a neurologist, neurosurgeon, orthopaedist, otolaryngologist, posturologist, vascular surgeon; radiologist, haematologist, gnathologist, maxillofacial surgeon, cardiologist, physiotherapist and others.

When to call the doctor?

Mild paresthesia, which occurs only once and perhaps after holding an ‘uncomfortable’ position for a long time, may be completely normal and should not cause concern.

On the contrary, a severe paresthesia, which recurs for no apparent reason and often, should be investigated by the doctor: in some cases, tingling or burning may in fact be the signs of a serious condition or pathology that needs to be evaluated immediately.

The single emergency number 112 should be called especially when paresthesia is associated with serious symptoms such as

• change in level of consciousness or alertness
• change in mental state
• sudden change in behaviour (e.g. confusional state, delirium, lethargy, hallucinations)
• confusion;
• difficulty in speaking;
• numbness or weakness in one side of the body;
• difficulty in movement;
• altered sensibility;
• paralysis;
• sudden changes in vision;
• loss of vision;
• ocular pain;
• urinary incontinence;
• faecal incontinence;
• fainting;
• erectile deficit or anorgasmia.

When paresthesia occurs on a continuous, invasive basis, follows trauma to the head, neck or back, and there is a sensation that it is spreading throughout the body, it is essential to seek medical attention.

Therapies and remedies for paresthesias

There is no single therapy that is valid in all cases: instead, there are various types of therapies that can be used to treat the underlying factor that causes paresthesia.

To reduce tingling in the feet and toes, there are, however, tips that are always valid, such as avoiding wearing high heels or shoes that grip the toes too tightly.

If you just can’t give up this habit, make use of insoles and buy high-quality shoes.

Take care not to do high-impact workouts by stretching before exercising, again with appropriate running and gym shoes on flat surfaces.

Choose good alternative sports that do not cause tingling, including swimming and cycling, and try to lose weight as much as possible, as overweight and obesity are known to increase this uncomfortable sensation.

Since sitting cross-legged or cross-legged for long periods can lead to numbness, change position often to help blood circulation and release choked arteries.

Wear compression stockings and socks to increase the sensitivity of your toes, reduce alcohol and keep your feet warm with a heated blanket.

Some exercises may reduce paresthesia and the lumbosacral and/or neck pain that is often associated with it

Exercises that may decrease paresthesias of the lower back, buttocks and lower limbs and lumbosacral pain

• exercise 1: sitting with your legs apart, bend forward slowly until you first touch one foot, then the other foot; then rise slowly until you are back with your shoulders and back straight and bring your arms up with your hands joined;
• exercise 2: standing with your legs slightly apart, place your hands behind your back just above your buttocks, then slowly extend your back back while keeping your knees straight.

Exercises that may decrease paresthesias of the neck, head, shoulders and upper limbs and neck pain:

• exercise 1: standing or sitting, slowly bend your neck sideways, pausing for a few seconds between bends in the starting position;
• exercise 2: standing or sitting, slowly bend your neck to the side; with the hand of the side to which your neck is bent, grasp the wrist of the opposite arm and pull it slightly downwards so that the trapezius and contralateral shoulder muscles are tensed; hold the position for 20 seconds and change sides;
• exercise 3: standing up, slowly bend your neck sideways; with the hand of the side to which your head is bent, push your head down slightly so as to apply tension; bend your other arm to 90º bringing your hand behind your back; hold the position for 20 seconds and change sides
• exercise 4: standing or sitting with your back erect, slowly bend your neck to the right, back, left and forward so as to perform a complete head circle; keep your shoulders and neck relaxed throughout the movement and repeat in the opposite direction.

In addition, stretching exercises, to be performed under medical supervision, can improve the situation.

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Source:

Medicina Online