Paresthesia

Last updated
Paresthesia
Other namesParaesthesia
Pronunciation
Specialty Neurology

Paresthesia is an abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) with no apparent physical cause. [1] Paresthesia may be transient or chronic, and may have many possible underlying causes. [1] Paresthesias are usually painless and can occur anywhere on the body, but most commonly occur in the arms and legs. [1]

Contents

The most familiar kind of paresthesia is the sensation known as "pins and needles" after having a limb "fall asleep". A less well-known and uncommon paresthesia is formication, the sensation of insects crawling on the skin.

Causes

Transient

The eponymous objects Pinsandneedles.jpg
The eponymous objects

Paresthesias of the hands, feet, legs, and arms are common transient symptoms. The briefest electric shock type of paresthesia can be caused by tweaking the ulnar nerve near the elbow; this phenomenon is colloquially known as bumping one's "funny bone". Similar brief shocks can be experienced when any other nerve is tweaked (e.g. a pinched neck nerve may cause a brief shock-like paresthesia toward the scalp). In the older age group, spinal column irregularities may tweak the spinal cord briefly when the head or back is turned, flexed, or extended into brief uncommon positions (Lhermitte's sign).[ citation needed ]

The most common everyday cause is temporary restriction of nerve impulses to an area of nerves, commonly caused by leaning or resting on parts of the body such as the legs (often followed by a pins and needles tingling sensation). Other causes include conditions such as hyperventilation syndrome and panic attacks. A cold sore outside the mouth (not a canker sore inside the mouth) can be preceded by tingling due to activity of the causative herpes simplex virus. The varicella zoster virus (shingles) also notably may cause recurring pain and tingling in skin or tissue along the distribution path of that nerve (most commonly in the skin, along a dermatome pattern, but sometimes feeling like a headache, chest or abdominal pain, or pelvic pain).[ citation needed ]

Other common examples occur when sustained pressure has been applied over a nerve, inhibiting or stimulating its function. Removing the pressure typically results in gradual relief of these paresthesias. [1] Most pressure-induced paraesthesia results from awkward posture, such as engaging in cross-legged sitting for prolonged periods of time. [2]

Reactive hyperaemia, which occurs when blood flow is restored after a period of ischemia, may be accompanied by paresthesia, e.g. when patients with Raynaud's disease rewarm after a cold episode. [3]

Cases of paresthesia have also been reported at varying frequencies following anthrax, [4] flu, [5] [6] HPV [7] and COVID-19 [8] [9] vaccine intake.

Chronic

Chronic paresthesia (Berger's paresthesia, [10] Sinagesia, [11] or Bernhardt paresthesia) [12] indicates either a problem with the functioning of neurons, or poor circulation.[ citation needed ]

In older individuals,[ definition needed ] paresthesia is often the result of poor circulation in the limbs (such as in peripheral vascular disease), most often caused by atherosclerosis, the build-up of plaque within artery walls over decades, with eventual plaque ruptures, internal clots over the ruptures, and subsequent clot healing, but leaving behind narrowing or closure of the artery openings, locally and/or in downstream smaller branches. Without a proper supply of blood and nutrients, nerve cells can no longer adequately send signals to the brain. Because of this, paresthesia can also be a symptom of vitamin deficiency or other malnutrition, as well as metabolic disorders like diabetes, hypothyroidism, or hypoparathyroidism. It can also be a symptom of mercury poisoning.[ citation needed ]

Irritation to the nerve can also come from inflammation to the tissue. Joint conditions such as rheumatoid arthritis, psoriatic arthritis, and carpal tunnel syndrome are common sources of paresthesia. Nerves below the head may be compressed where chronic neck and spine problems exist, and can be caused by, among other things, muscle cramps that may be a result of clinical anxiety or excessive mental stress,[ citation needed ] bone disease, poor posture, unsafe heavy lifting practices, or physical trauma such as whiplash. Paresthesia can also be caused simply by putting pressure on a nerve by applying weight (or pressure) to the limb for extended periods of time.[ citation needed ]

Another cause of paresthesia may be direct damage to the nerves themselves, i.e., neuropathy, which itself can stem from injury, such as from frostbite; infections such as Lyme disease; or may be indicative of a current neurological disorder. Neuropathy is also a side effect of some chemotherapies, such as in the case of chemotherapy-induced peripheral neuropathy. [13] Benzodiazepine withdrawal may also cause paresthesia, as the drug removal leaves the GABA receptors stripped bare and possibly malformed.[ clarification needed ][ citation needed ] Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a transient ischemic attack; or autoimmune diseases such as multiple sclerosis, complex regional pain syndrome, or lupus erythematosus.[ citation needed ] The use of fluoroquinolones can also cause paresthesia. [14] Stroke survivors and those with traumatic brain injury (TBI) may experience paresthesia from damage to the central nervous system.[ citation needed ]

The varicella zoster virus disease (shingles) can attack nerves, causing numbness instead of the pain commonly associated with shingles.[ citation needed ]

Acroparesthesia

Acroparesthesia is severe pain in the extremities, and may be caused by Fabry disease, a type of sphingolipidosis. [15]

It can also be a sign of hypocalcemia. [16]

Dentistry

Dental paresthesia is loss of sensation caused by maxillary or mandibular anesthetic administration before dental treatment. [17]

Potential causes include trauma introduced to the nerve sheath during administration of the injection, hemorrhage about the sheath, more side-effect-prone types of anesthetic being used, or administration of anesthetic contaminated with alcohol or sterilizing solutions. [18]

Other

Other causes may include:

Drugs

Diagnostics

A nerve conduction study usually provides useful information for making a diagnosis. An MRI or a CT scan is sometimes used to rule out certain causes stemming from central nervous system issues.[ citation needed ]

Treatment

Medications offered can include the immunosuppressant prednisone, intravenous gamma globulin (IVIG), anticonvulsants such as gabapentin or tiagabine, or antiviral medication, depending on the underlying cause.[ medical citation needed ]

In addition to treatment of the underlying disorder, palliative care can include the use of topical numbing creams, such as lidocaine or prilocaine. Ketamine has also been successfully used, but is generally not approved by insurance. Careful consideration must be taken to apply only the necessary amount, as excess can contribute to these conditions. Otherwise, these products generally offer extremely effective, but short-lasting relief from these conditions.

Paresthesia caused by stroke may receive some temporary benefit from high doses of baclofen multiple times a day.[ citation needed ] HIV patients who self-medicate with cannabis report that it reduces their symptoms. [23]

Paresthesia caused by shingles is treated with appropriate antiviral medication. [24]

Etymology

The word paresthesia ( /ˌpærɪsˈθiːziə,-ʒə/ ; British English paraesthesia; plural paraesthesiae /-zii/ or paraesthesias) comes from the Greek para ("beside", i.e., abnormal) and aisthesia ("sensation"). [25]

Related Research Articles

<span class="mw-page-title-main">Ramsay Hunt syndrome type 2</span> Presentation of shingles in the geniculate ganglion

Ramsay Hunt syndrome type 2, commonly referred to simply as Ramsay Hunt syndrome (RHS) and also known as herpes zoster oticus, is inflammation of the geniculate ganglion of the facial nerve as a late consequence of varicella zoster virus (VZV). In regard to the frequency, less than 1% of varicella zoster infections involve the facial nerve and result in RHS. It is traditionally defined as a triad of ipsilateral facial paralysis, otalgia, and vesicles close to the ear and auditory canal. Due to its proximity to the vestibulocochlear nerve, the virus can spread and cause hearing loss, tinnitus, and vertigo. It is common for diagnoses to be overlooked or delayed, which can raise the likelihood of long-term consequences. It is more complicated than Bell's palsy. Therapy aims to shorten its overall length, while also providing pain relief and averting any consequences.

<span class="mw-page-title-main">Carpal tunnel syndrome</span> Medical condition

Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with nerve compression of the median nerve at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunnel. Idiopathic means that there is no other disease process contributing to pressure on the nerve. As with most structural issues, it occurs in both hands, and the strongest risk factor is genetics.

<span class="mw-page-title-main">Benign fasciculation syndrome</span> Involuntary muscle twitching in the voluntary muscles

Benign fasciculation syndrome (BFS) is characterized by fasciculation (twitching) of voluntary muscles in the body. The twitching can occur in any voluntary muscle group but is most common in the eyelids, arms, hands, fingers, legs, and feet. The tongue can also be affected. The twitching may be occasional to continuous. BFS must be distinguished from other conditions that include muscle twitches.

<span class="mw-page-title-main">Shingles</span> Viral disease caused by the varicella zoster virus

Shingles, also known as herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area. Typically the rash occurs in a single, wide mark either on the left or right side of the body or face. Two to four days before the rash occurs there may be tingling or local pain in the area. Other common symptoms are fever, headache, and tiredness. The rash usually heals within two to four weeks; however, some people develop ongoing nerve pain which can last for months or years, a condition called postherpetic neuralgia (PHN). In those with poor immune function the rash may occur widely. If the rash involves the eye, vision loss may occur.

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.

<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerves are affected. Neuropathies affecting motor, sensory, or autonomic nerves result in different symptoms. More than one type of nerve may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

Postherpetic neuralgia (PHN) is neuropathic pain that occurs due to damage to a peripheral nerve caused by the reactivation of the varicella zoster virus. PHN is defined as pain in a dermatomal distribution that lasts for at least 90 days after an outbreak of herpes zoster. Several types of pain may occur with PHN including continuous burning pain, episodes of severe shooting or electric-like pain, and a heightened sensitivity to gentle touch which would not otherwise cause pain or to painful stimuli. Abnormal sensations and itching may also occur.

<span class="mw-page-title-main">Formication</span> Abnormal sensation that bugs are crawling on or under the skin

Formication is the sensation resembling that of small insects crawling on the skin, in the absence of actual insects. It is one specific form of a set of sensations known as paresthesias, which also include the more common prickling, tingling sensation known as pins and needles. Formication is a well-documented symptom which has numerous possible causes. The word is derived from formica, the Latin word for ant.

<span class="mw-page-title-main">Neuritis</span> Inflammation of a nerve or generally any part of the nervous system

Neuritis, from the Greek νεῦρον), is inflammation of a nerve or the general inflammation of the peripheral nervous system. Inflammation, and frequently concomitant demyelination, cause impaired transmission of neural signals and leads to aberrant nerve function. Neuritis is often conflated with neuropathy, a broad term describing any disease process which affects the peripheral nervous system. However, neuropathies may be due to either inflammatory or non-inflammatory causes, and the term encompasses any form of damage, degeneration, or dysfunction, while neuritis refers specifically to the inflammatory process.

Meralgia paresthetica or meralgia paraesthetica is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve that extends from the spinal column to the thigh.

<span class="mw-page-title-main">Chronic inflammatory demyelinating polyneuropathy</span> Medical condition

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired autoimmune disease of the peripheral nervous system characterized by progressive weakness and impaired sensory function in the legs and arms. The disorder is sometimes called chronic relapsing polyneuropathy (CRP) or chronic inflammatory demyelinating polyradiculoneuropathy. CIDP is closely related to Guillain–Barré syndrome and it is considered the chronic counterpart of that acute disease. Its symptoms are also similar to progressive inflammatory neuropathy. It is one of several types of neuropathy.

Dysesthesia is an unpleasant, abnormal sense of touch. Its etymology comes from the Greek word "dys," meaning "bad," and "aesthesis," which means "sensation". It often presents as pain 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. Dysesthesia can include sensations in any bodily tissue, including most often the mouth, scalp, skin, or legs.

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 some skin sensations and help control autonomic function. It is estimated that 15–20 million people in the United States have some form of peripheral neuropathy.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

<span class="mw-page-title-main">Idiopathic Ulnar neuropathy at the elbow</span> Medical condition

Idiopathic Ulnar neuropathy at the elbow is a condition where pressure on the ulnar nerve as it passes through the cubital tunnel causes nerve dysfunction (neuropathy). The symptoms of neuropathy are paresthesia (tingling) and numbness primarily affecting the little finger and ring finger of the hand. Ulnar neuropathy can progress to weakness and atrophy of the muscles in the hand. Symptoms can be alleviated by attempts to keep the elbow from flexing while sleeping, such as sticking one's arm in the pillow case, so the pillow restricts flexion.

Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. Typically, both sides of the body are involved, and the initial symptoms are changes in sensation or pain often in the back along with muscle weakness, beginning in the feet and hands, often spreading to the arms and upper body. The symptoms may develop over hours to a few weeks. During the acute phase, the disorder can be life-threatening, with about 15% of people developing weakness of the breathing muscles and, therefore, requiring mechanical ventilation. Some are affected by changes in the function of the autonomic nervous system, which can lead to dangerous abnormalities in heart rate and blood pressure.

<span class="mw-page-title-main">Hereditary neuropathy with liability to pressure palsy</span> Medical condition

Hereditary neuropathy with liability to pressure palsy (HNPP) is a peripheral neuropathy, a condition that affects the nerves. Pressure on the nerves can cause tingling sensations, numbness, pain, weakness, muscle atrophy and even paralysis of the affected area. In normal individuals, these symptoms disappear quickly, but in sufferers of HNPP even a short period of pressure can cause the symptoms to occur. Palsies can last from minutes or days to weeks or even months.

<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 chronic, direct pressure on a peripheral 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. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage. A surgical nerve decompression can relieve pressure on the nerve but cannot always reverse the physiological changes that occurred before treatment. Nerve injury by a single episode of physical trauma is in one sense an acute compression neuropathy but is not usually included under this heading, as chronic compression takes a unique pathophysiological course.

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.

<span class="mw-page-title-main">Herpes zoster ophthalmicus</span> Shingles in the human eye

Herpes zoster ophthalmicus (HZO), also known as ophthalmic zoster, is shingles involving the eye or the surrounding area. Common signs include a rash of the forehead with swelling of the eyelid. There may also be eye pain and redness, inflammation of the conjunctiva, cornea or uvea, and sensitivity to light. Fever and tingling of the skin and allodynia near the eye may precede the rash. Complications may include visual impairment, increased pressure within the eye, chronic pain, and stroke.

References

  1. 1 2 3 4 "Paresthesia Information Page". National Institute of Neurological Disorders and Stroke. 2019-03-27. Archived from the original on 2020-11-11. Retrieved 2021-03-12.
  2. ↑ "Paresthesia | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Archived from the original on 2022-05-17. Retrieved 2022-11-18.
  3. ↑ Belch JJ, McCollum PT, Walker WF, Stonebridge PA (1996). Color atlas of peripheral vascular diseases. Mosby-Wolfe. p. 77. ISBN   978-0-7234-2074-3.
  4. ↑ Sever, John L.; Brenner, Alan I.; Gale, Arnold D.; Lyle, Jerry M.; Moulton, Lawrence H.; West, David J. (2002-05-03). "Safety of anthrax vaccine: a review by the Anthrax Vaccine Expert Committee (AVEC) of adverse events reported to the Vaccine Adverse Event Reporting System (VAERS)". Pharmacoepidemiology and Drug Safety. 11 (3): 189–202. doi:10.1002/pds.712. ISSN   1053-8569. PMID   12051118. S2CID   43578539. Archived from the original on 2022-11-07. Retrieved 2022-11-07.
  5. ↑ Durrieu, Geneviève; Caillet, Céline; Lacroix, Isabelle; Jacquet, Alexis; Faucher, Angeline; Ouaret, Shéhérazade; Sommet, Agnès; Perault-Pochat, Marie-Christine; Kreft-Jaïs, Carmen; Castot, Anne; Damase-Michel, Christine; Montastruc, Jean-Louis (November–December 2011). "Campagne nationale de vaccination contre la grippe A (H1N1)v : suivi national de pharmacovigilance". Therapies (in French). 66 (6): 527–540. doi:10.2515/therapie/2011075. PMID   22186078. Archived from the original on 2023-03-13. Retrieved 2022-11-07.
  6. ↑ Serres, Gaston De; Gariépy, Marie-Claude; Coleman, Brenda; Rouleau, Isabelle; McNeil, Shelly; Benoît, Mélanie; McGeer, Allison; Ambrose, Ardith; Needham, Judy; Bergeron, Chantal; Grenier, Cynthia; Sleigh, Kenna; Kallos, Arlene; Ouakki, Manale; Ouhoummane, Najwa (2012-07-03). "Short and Long-Term Safety of the 2009 AS03-Adjuvanted Pandemic Vaccine". PLOS ONE. 7 (7): e38563. Bibcode:2012PLoSO...738563D. doi: 10.1371/journal.pone.0038563 . ISSN   1932-6203. PMC   3389012 . PMID   22802929.
  7. ↑ Martínez-Lavín, Manuel (2015-05-20). "Hypothesis: Human papillomavirus vaccination syndrome—small fiber neuropathy and dysautonomia could be its underlying pathogenesis". Clinical Rheumatology. 34 (7): 1165–1169. doi:10.1007/s10067-015-2969-z. ISSN   0770-3198. PMID   25990003. S2CID   10315339. Archived from the original on 2023-07-02. Retrieved 2022-11-07.
  8. ↑ Yong, Shin-Jie; Halim, Alice; Halim, Michael; Al Mutair, Abbas; Alhumaid, Saad; Al-Sihati, Jehad; Albayat, Hawra; Alsaeed, Mohammed; Garout, Mohammed; Al Azmi, Reyouf; Aldakheel, Noor; Alshukairi, Abeer N.; Al Ali, Hani A.; Almoumen, Adel A.; Rabaan, Ali A. (2022-07-02). "Rare Adverse Events Associated with BNT162b2 mRNA Vaccine (Pfizer-BioNTech): A Review of Large-Scale, Controlled Surveillance Studies". Vaccines. 10 (7): 1067. doi: 10.3390/vaccines10071067 . ISSN   2076-393X. PMC   9319660 . PMID   35891231.
  9. ↑ Allahyari, Fakhri; Molaee, Hamideh; Nejad, Javad Hosseini (2022-09-12). "Covid-19 vaccines and neurological complications: a systematic review". Zeitschrift für Naturforschung C. 78 (1–2): 1–8. doi: 10.1515/znc-2022-0092 . ISSN   1865-7125. PMID   36087300. S2CID   252181197.
  10. ↑ [ICD-10: R20.2]
  11. ↑ [ICD-10: R25.1]
  12. ↑ [ICD-10: G57.1]
  13. ↑ "Chemotherapy-induced Peripheral Neuropathy". National Cancer Institute. Archived from the original on 11 December 2011. Retrieved 1 December 2011.
  14. ↑ "FDA Drug Safety Communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection". Food & Drug Administration. Archived from the original on 28 May 2016. Retrieved 28 May 2016.
  15. ↑ Marks, Dawn B.; Swanson, Todd; Kim, Sandra I.; Glucksman, Marc (2007). Biochemistry and Molecular biology . Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN   978-0-7817-8624-9.
  16. ↑ "Part 10.1: Life-Threatening Electrolyte Abnormalities". Circulation. 112 (24_supplement): IV-125. 13 December 2005. doi: 10.1161/CIRCULATIONAHA.105.166563 . S2CID   79026294. Symptoms of hypocalcemia usually occur when ionized levels fall to <2.5 mg/dL. Symptoms include paresthesias of the extremities and face, followed by muscle cramps, carpopedal spasm, stridor, tetany, and seizures.
  17. ↑ Ahmad, Maha (2018-02-22). "The Anatomical Nature of Dental Paresthesia: A Quick Review". The Open Dentistry Journal. 12: 155–159. doi: 10.2174/1874210601812010155 . ISSN   1874-2106. PMC   5838625 . PMID   29541262.
  18. ↑ Garisto, G; Gaffen, A; Lawrence, H; Tenenbaum, H; Haas, D (Jul 2010). "Occurrence of Paresthesia After Dental Local Anesthetic Administration in the United States". The Journal of the American Dental Association. 141 (7): 836–844. doi: 10.14219/jada.archive.2010.0281 . PMID   20592403.
  19. ↑ Tihanyi, Benedek T.; Ferentzi, Eszter; Beissner, Florian; Köteles, Ferenc (1 February 2018). "The neuropsychophysiology of tingling". Consciousness and Cognition. 58: 97–110. doi:10.1016/j.concog.2017.10.015. ISSN   1053-8100. PMID   29096941. S2CID   46885551.
  20. ↑ Vijverberg, H.P., van den Bercken, J. Crit. Rev. Toxicol. (1990) Neurotoxicological effects and the mode of action of pyrethroid insecticides.
  21. ↑ "Nitrous Oxide". Archived from the original on 2013-05-13. Retrieved 2016-03-05.
  22. ↑ Scully, C.; Diz Dios, P. (2001). "Orofacial effects of antiretroviral therapies". Oral Diseases. 7 (4): 205–210. doi:10.1034/j.1601-0825.2001.70401.x. PMID   11575869. Archived from the original on 2022-06-13. Retrieved 2022-06-13.
  23. ↑ Woolridge Emily; et al. (2005). "Cannabis use in HIV for pain and other medical symptoms". Journal of Pain and Symptom Management. 29 (4): 358–367. doi: 10.1016/j.jpainsymman.2004.07.011 . PMID   15857739.
  24. ↑ Cohen KR, Salbu RL, Frank J, Israel I (2013). "Presentation and management of herpes zoster (shingles) in the geriatric population". P T. 38 (4): 217–27. PMC   3684190 . PMID   23785227.
  25. ↑ "Paresthesia Definition and Origin". dictionary.com. Archived from the original on 12 August 2015. Retrieved 1 August 2015. Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.
    Most people have experienced temporary paresthesia -- a feeling of "pins and needles" -- at some time in their lives when they have sat with legs crossed for too long, or fallen asleep with an arm crooked under their head. It happens when sustained pressure is placed on a nerve. The feeling quickly goes away once the pressure is relieved.
    Chronic paresthesia is often a symptom of an underlying neurological disease or traumatic nerve damage. Paresthesia can be caused by disorders affecting the central nervous system, such as stroke and transient ischemic attacks (mini-strokes), multiple sclerosis, transverse myelitis, and encephalitis. A tumor or vascular lesion pressed up against the brain or spinal cord can also cause paresthesia. Nerve entrapment syndromes, such as carpal tunnel syndrome, can damage peripheral nerves and cause paresthesia accompanied by pain. Diagnostic evaluation is based on determining the underlying condition causing the paresthetic sensations. An individual's medical history, physical examination, and laboratory tests are essential for the diagnosis. Physicians may order additional tests depending on the suspected cause of the paresthesia.

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