Dysesthesia

Dysesthesia
Dysesthesia
Other names	dysaesthesia
Specialty	Neurology

Last updated February 22, 2023

Dysesthesia is an unpleasant, abnormal sense of touch. Its etymology comes from the Greek word "dys," meaning "bad," and "aesthesis," which means "sensation" (abnormal sensation). It often presents as pain ^[1] but may also present as an inappropriate, but not discomforting, sensation. It is caused by lesions of the nervous system, peripheral or central, and it involves sensations, whether spontaneous or evoked, such as burning, wetness, itching, electric shock, and pins and needles.^[1] Dysesthesia can include sensations in any bodily tissue, including most often the mouth, scalp, skin, or legs.^[1]

It is sometimes described as feeling like acid under the skin. Burning dysesthesia might accurately reflect an acidotic state in the synapses and perineural space. Some ion channels will open to a low pH, and the acid sensing ion channel has been shown to open at body temperature, in a model of nerve injury pain. Inappropriate, spontaneous firing in pain receptors has also been implicated as a cause of dysesthesia.^{[ citation needed ]}

People with dysesthesia can become incapacitated with pain, despite no apparent damage to the skin or other tissue.^{[ citation needed ]}

Types

Dysesthesia can generally be described as a class of neurological disorders. It can be further classified depending on where it manifests in the body, and by the type of sensation that it provokes.^{[ citation needed ]}

Cutaneous dysesthesia is characterized by discomfort or pain from touch to the skin by normal stimuli, including clothing. The unpleasantness can range from a mild tingling to blunt, incapacitating pain.^{[ citation needed ]}

Scalp dysesthesia is characterized by pain or burning sensations on or under the surface of the cranial skin. Scalp dysesthesia may also present as excessive itching of the scalp.^{[ citation needed ]}

Occlusal dysesthesia, or "phantom bite," is characterized by the feeling that the bite is "out of place" (occlusal dystopia) despite any apparent damage or instability to dental or oromaxillofacial structures or tissue. Phantom bite often presents in patients that have undergone otherwise routine dental procedures. Short of compassionate counseling, evidence for effective treatment regimes is lacking.

Presentation

Chronic anxiety is often associated with dysesthesia due to extreme stress.^[2] Patients with this anxiety may experience numbness or tingling in the face. In one study, those patients that were examined psychologically had symptoms of anxiety, depression, obsessive-compulsive personality disorder, or somatic symptom disorder.^[3]

Causes

Dysesthesia is commonly seen in diabetic patients, and can be relieved by using creams containing capsaicin.
Dysesthesia may be seen in patients with Guillain–Barré syndrome.
Dysesthesia is among symptoms of neuropathy (along with paresthesias, gait disturbance, weakness, and absent DTRs).
Dysesthesia, along with polyneuropathy can be a symptom of nerve damage caused by Lyme disease.^[4] The dysesthetic sensations continue after the successful antibiotic treatment of Lyme disease.
Dysesthesia is a common symptom of a withdrawal from alcohol or other drugs.
Dysesthesia is also a common symptom of multiple sclerosis. It is an effect of spinal cord injury.^[5]
Many patients with occlusal dysesthesia have reported recent oral surgery before the onset of dysesthetic pain.^[3]
Late-onset GM2 gangliosidosis may also present as burning dysesthesia.^[6]
Chemotherapy-induced peripheral neuropathy is a progressive, enduring and often irreversible tingling numbness, intense pain, and hypersensitivity to cold, beginning in the hands and feet and sometimes involving the arms and legs caused by some chemotherapy agents.^[7]
Dysesthesia may be caused by a thalamic stroke involving the ventral postero-lateral (VPL) nucleus. It's typically seen in Dejerine-Roussy syndrome with hemi-sensory loss and severe dysesthesia of the affected area.
Fibromyalgia may cause dysesthesia in all areas of the body, but mostly the extremities. ^{[ medical citation needed ]}
Dysesthesia is usually seen and presented in vCJD disease or also called Frank Pains due to vCJD nerve alteration.

Diagnosis

Differential diagnosis

Although dysesthesia is similar to phantom limb syndrome, they should not be confused. In phantom limb, the sensation is present in an amputated or absent limb, while dysesthesia refers to discomfort or pain in a tissue that has not been removed or amputated. The dysesthetic tissue may also not be part of a limb, but part of the body, such as the abdomen. The majority of individuals with both phantom limb and dysesthesia experience painful sensations.^{[ citation needed ]}

Phantom pain refers to dysesthetic feelings in individuals who are paralyzed or who were born without limbs. It is caused by the improper innervation of the missing limbs by the nerves that would normally innervate the limb. Dysesthesia is caused by damage to the nerves themselves, rather than by an innervation of absent tissue.^{[ citation needed ]}

Dysesthesia should not be confused with anesthesia or hypoesthesia, which refer to a loss of sensation, or paresthesia which refers to a distorted sensation. Dysesthesia is distinct in that it can, but not necessarily, refer to spontaneous sensations in the absence of stimuli. In the case of an evoked dysesthetic sensation, such as by the touch of clothing, the sensation is characterized not simply by an exaggeration of the feeling, but rather by a completely inappropriate sensation such as burning.

Treatment

Daily oral muscle physical therapy, or the administration of antidepressants have been reported as effective therapy for occlusal dysesthesia patients.^[3] Tooth grinding, and the replacement or removal of all dental work should be avoided in patients with occlusal dysesthesia,^[3] despite the frequent requests for further surgery often made by these patients.

Antidepressants are also often prescribed for scalp dysesthesia.

Prakash et al. found that many patients with burning mouth syndrome (BMS), one variant of occlusal dysesthesia, also report painful sensations in other parts of the body. Many of the patients with BMS met the classification of restless leg syndrome (RLS). About half of these patients also had a family history of RLS. These results suggest that some BMS symptoms may be caused by the same pathway as RLS in some patients, indicating that dopaminergic drugs regularly used to treat RLS may be effective in treating BMS as well.

Research

There are a number of hypotheses regarding the basis of occlusal dysesthesia. Some researchers believe the disorder is a psychological one, while others believe it to be a psychosomatic disorder.^[3] Joseph Marbach hypothesized that the symptoms were rooted in psychiatric disorders. Marbach suggested that occlusal dysesthesia would occur in patients with underlying psychological problems (such as schizophrenia) after having undergone dental treatment. More recently, two studies have found that occlusal dysesthesia is associated with somatoform disorders in which the patients obsess over the oral sensations.

Similarly, Marbach later proposed that occlusal dysesthesia may be caused by the brain “talking to itself,” causing abnormal oral sensations in the absence of external stimuli. According to this model, the symptoms of dysesthesia are catalyzed by dental “amputation,” for example the extraction of a tooth, whereby the brain loses the ability to distinguish between its memory of the bite and the actual, new bite. The patient, unable to recognize his or her own bite, becomes especially attentive to these perceived oral discrepancies. Finally and most recently, Greene and Gelb suggested that instead of having a psychological root, dysesthesia may be caused by a false signal being sent from the peripheral nervous system to the central nervous system. However, the reviewers note that no method exists for determining sensor nerve thresholds, and so sensory perception in the mouth is often measured by interdental thickness discrimination (ITD), or the ability to differentiate between the sizes of objects (thin blocks) placed between teeth. In one study, occlusal dysesthesia patients showed greater ability to differentiate these thicknesses than control, healthy individuals, but these differences were not statistically significant.

Studies

Bennett et al. produced an artificial peripheral mononeuropathy in rats by surgically constricting the sciatic nerve.^[8] These rats showed an increased response to noxious radiant heat, were nocifensive when placed on a cold metal floor, protected their hind paws, and had suppressed appetite. Additionally, the paws of many of these rats were inappropriately warm or cool to the touch, and many of the rats overgrew claws on the affected paws as well. These results indicate that the rats exhibited hyperalgesia, allodynia, and dysesthesia.^{[ citation needed ]}
In a study in which researchers cut spinal nerves in rats, researchers found these rats exhibited a longer duration in spontaneous foot lifting, hypersensitivity to mechanical stimuli, allodynia, and hyperalgesia.^[9] Additionally, the receptive field neurons in this nerve pathway showed spontaneous firing in low-threshold nociceptors, suggesting that nerve damage can cause dysesthesia.
In women with chronic pain or itchy scalps without any apparent physical cause, about half had from psychiatric disorders. For the majority of these women, their symptoms of scalp dysesthesia were alleviated or removed by treatment with low doses of antidepressants.^[10]
Landerholm et al. hypothesized that dynamic mechanical allodynia (DMA) might be the hyperbole of dynamic mechanical dysesthesia (DMD), mediated by peripheral nerves. When the researchers artificially blocked nerves in patients with peripheral neuropathic pain or central post-stroke pain, DMA symptoms in many of the patients transitioned into DMD symptoms. Additionally, the researchers determined that the number of mechanocreceptive fibers associated with the nociceptive system was responsible for the differentiation of DMA to DMD.^[11]
Ochoa et al. recorded intraneural signals in subjects with post-ischaemic paraesthesiae. The researchers found the signals to be spontaneous. The frequency of the signals paralleled the intensity and timing of the paresthetic sensations reported by the patients. These results suggest that paresthetic sensations are the result of inappropriate firing frequency and timing by impulses from sensory cells.^[12]
Tuskiyama et al. assessed occlusal dysesthesia patients using an interdental thickness discrimination test and a psychological examination. The researchers found that occlusal dysesthesia patients could not discriminate the thickness of material in their bite any better than normal dental patients, but that the occlusal dysesthesia patients were significantly more likely to exhibit psychological disorders.^[13]

Related Research Articles

Complex regional pain syndrome (CRPS) is any of several painful conditions that are characterized by a continuing regional pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. Usually starting in a limb, it manifests as pain, swelling, limited range of motion, and/or changes to the skin and bones. It may initially affect one limb and then spread throughout the body; 35% of affected people report symptoms throughout their whole bodies. Two types exist: reflex sympathetic dystrophy (RSD) and causalgia. Having both types is possible.

A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general anesthetic. When it is used on specific nerve pathways, paralysis also can be achieved.

Paresthesia is an abnormal sensation of the skin with no apparent physical cause. Paresthesia may be transient or chronic, and may have any of dozens of possible underlying causes. Paresthesias are usually painless and can occur anywhere on the body, but most commonly occur in the arms and legs.

Diabetic neuropathy is various types of nerve damage associated with diabetes mellitus. Symptoms depend on the site of nerve damage and can include motor changes such as weakness; sensory symptoms such as numbness, tingling, or pain; or autonomic changes such as urinary symptoms. These changes are thought to result from a microvascular injury involving small blood vessels that supply nerves. Relatively common conditions which may be associated with diabetic neuropathy include distal symmetric polyneuropathy; third, fourth, or sixth cranial nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; and autonomic neuropathy.

Toothache, also known as dental pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.

Neuropathic pain is pain caused by damage or disease affecting the somatosensory system. Neuropathic pain may be associated with abnormal sensations called dysesthesia or pain from normally non-painful stimuli (allodynia). It may have continuous and/or episodic (paroxysmal) components. The latter resemble stabbings or electric shocks. Common qualities include burning or coldness, "pins and needles" sensations, numbness and itching.

Neurotmesis is part of Seddon's classification scheme used to classify nerve damage. It is the most serious nerve injury in the scheme. In this type of injury, both the nerve and the nerve sheath are disrupted. While partial recovery may occur, complete recovery is impossible.

Pulpitis is inflammation of dental pulp tissue. The pulp contains the blood vessels, the nerves, and connective tissue inside a tooth and provides the tooth's blood and nutrients. Pulpitis is mainly caused by bacterial infection which itself is a secondary development of caries. It manifests itself in the form of a toothache.

Burning mouth syndrome (BMS) is a burning, tingling or scalding sensation in the mouth, lasting for at least four to six months, with no underlying known dental or medical cause. No related signs of disease are found in the mouth. People with burning mouth syndrome may also have a subjective xerostomia, paraesthesia, or an altered sense of taste or smell.

Small fiber peripheral neuropathy is a type of peripheral neuropathy that occurs from damage to the small unmyelinated and myelinated peripheral nerve fibers. These fibers, categorized as C fibers and small Aδ fibers, are present in skin, peripheral nerves, and organs. The role of these nerves is to innervate the skin and help control autonomic function. It is estimated that 15–20 million people in the United States have some form of peripheral neuropathy.

Hyperpathia is a clinical symptom of certain neurological disorders wherein nociceptive stimuli evoke exaggerated levels of pain. This should not be confused with allodynia, where normally non-painful stimuli evoke pain.

Hypoesthesia or numbness is a common side effect of various medical conditions that manifests as a reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli. In everyday speech this is generally referred to as numbness.

Scalp dysesthesia is a cutaneous condition characterised by pain and burning sensations without objective physical examination findings. The pain sometimes is described as burning. Often there is an underlying psychosomatic cause, such as stress, depression or anxiety.

<span class="mw-page-title-main">Nerve compression syndrome</span> Human disease

Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by direct pressure on a nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. Nerve conduction studies help to confirm the diagnosis. In some cases, surgery may help to relieve the pressure on the nerve but this does not always relieve all the symptoms. Nerve injury by a single episode of physical trauma is in one sense a compression neuropathy but is not usually included under this heading.

Chemotherapy-induced peripheral neuropathy (CIPN) is a nerve-damaging side effect of antineoplastic agents in the common cancer treatment, chemotherapy. CIPN afflicts between 30% and 40% of patients undergoing chemotherapy. Antineoplastic agents in chemotherapy are designed to eliminate rapidly dividing cancer cells, but they can also damage healthy structures, including the peripheral nervous system. CIPN involves various symptoms such as tingling, pain, and numbness in the hands and feet. These symptoms can impair activities of daily living, such as typing or dressing, reduce balance, and increase risk of falls and hospitalizations. They can also give cause to reduce or discontinue chemotherapy. Researchers have conducted clinical trials and studies to uncover the various symptoms, causes, pathogenesis, diagnoses, risk factors, and treatments of CIPN.

Dentomandibular sensorimotor dysfunction (DMSD) is a medical condition involving the mandible, upper three cervical (neck) vertebrae, and the surrounding muscle and nerve areas.

Tactile hallucination is the false perception of tactile sensory input that creates a hallucinatory sensation of physical contact with an imaginary object. It is caused by the faulty integration of the tactile sensory neural signals generated in the spinal cord and the thalamus and sent to the primary somatosensory cortex (SI) and secondary somatosensory cortex (SII). Tactile hallucinations are recurrent symptoms of neurological diseases such as schizophrenia, Parkinson's disease, Ekbom's syndrome and delerium tremens. Patients who experience phantom limb pains also experience a type of tactile hallucination. Tactile hallucinations are also caused by drugs such as cocaine and alcohol.

Cancer pain can be caused by pressure on, or chemical stimulation of, specialised pain-signalling nerve endings called nociceptors, or by damage or illness affecting nerve fibers themselves.

Ocular neuropathic pain is a spectrum of disorders of ocular pain which are caused by damage or disease affecting the nerves. Ocular neuropathic pain is frequently associated with damaged or dysfunctional corneal nerves, but the condition can also be caused by peripheral or centralized sensitization. The condition shares some characteristics with somatic neuropathic pain in that it is similarly associated with abnormal sensations (dysesthesia) or pain from normally non-painful stimuli (allodynia), but until recent years has been poorly understood by the medical community, and frequently dismissed by ophthalmologists who were not trained to identify neuropathic pain as a source of unexplained eye pain beyond objective findings noted on slit-lamp examination.

Peripheral mononeuropathy is a nerve related disease where a single nerve, that is used to transport messages from the brain to the peripheral body, is diseased or damaged. Peripheral neuropathy is a general term that indicates any disorder of the peripheral nervous system. The name of the disorder itself can be broken down in order to understand this better; peripheral: in regard to peripheral neuropathy, refers to outside of the brain and spinal cord; neuro: means nerve related; -pathy; means disease. Peripheral mononeuropathy is a disorder that links to Peripheral Neuropathy, as it only effects a single peripheral nerve rather than several damaged or diseased nerves throughout the body. Healthy peripheral nerves are able to “carry messages from the brain and spinal cord to muscles, organs, and other body tissues”.

References

^[14]

1 2 3 IASP Pain Terminology Archived 2008-05-12 at the Wayback Machine .
↑ "How to Stop Chronic Anxiety From Dysesthesia". www.calmclinic.com.
1 2 3 4 5 Hara, E. S., Matsuka, Y., Minakuchi, H., Clark, G. T., & Kuboki, T. (2012). Occlusal dysesthesia: a qualitative systematic review of the epidemiology, aetiology and management. Journal of Oral Rehabilitation, 39(8): 630-638.
↑ Klempner, M. S., Hu, L. T., Evans, J., Schmid, C. H., Johnson, G. M., Trevino, R. P., . . . Weinstein, A. (2001). Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. New England Journal of Medicine, 345(2), 85-92.
↑ "Understanding Dysesthesia in Multiple Sclerosis". about.com.
↑ Chow, G. C. S., Clarke, J. T. R., & Banwell, B. L. (2001). Late-onset GM2 gangliosidosis presenting as burning dysesthesias. Pediatric Neurology, 25(1).
↑ del Pino BM (Feb 23, 2010). "Chemotherapy-induced Peripheral Neuropathy". NCI Cancer Bulletin. 7 (4): 6. Archived from the original on 2011-12-11.
↑ Bennett, G. J., & Xie, Y. K. (1988). A PERIPHERAL MONONEUROPATHY IN RAT THAT PRODUCES DISORDERS OF PAIN SENSATION LIKE THOSE SEEN IN MAN. Pain, 33(1).
↑ Djouhri, L., Fang, X., Koutsikou, S., & Lawson, S. N. (2012). Partial nerve injury induces electrophysiological changes in conducting (uninjured) nociceptive and nonnociceptive DRG neurons: Possible relationships to aspects of peripheral neuropathic pain and paresthesias. Pain, 153(9).
↑ Hoss, D., & Segal, S. (1998). Scalp dysesthesia. Archives of Dermatology, 134(3). doi: 10.1001/archderm.134.3.327
↑ Landerholm, A. H., & Hansson, P. T. (2011). Mechanisms of dynamic mechanical allodynia and dysesthesia in patients with peripheral and central neuropathic pain. European Journal of Pain, 15(5).
↑ Ochoa, J. L., & Torebjork, H. E. (1980). PARAESTHESIAE FROM ECTOPIC IMPULSE GENERATION IN HUMAN SENSORY NERVES. Brain, 103(DEC).
↑ Tsukiyama, Y., Yamada, A., Kuwatsuru, R., & Koyano, K. (2012). Bio-psycho-social assessment of occlusal dysaesthesia patients. Journal of Oral Rehabilitation, 39(8).
↑ Dysesthesia: 9 ways to reduce MS pain & abnormal sensation