Paresthesia

Paresthesia is a neurological condition characterized by abnormal sensations such as tingling, numbness, prickling, or burning that typically occurs without an apparent physical cause. The term “paresthesia” comes from Greek roots meaning “abnormal sensation.” Similarly, the alternative spelling “paraesthesia” refers to the same condition.

To define paresthesia properly, it’s important to understand that these sensations result from nerve dysfunction or damage affecting sensory pathways. While most people have experienced temporary paresthesia (like a “pins and needles” feeling when a limb “falls asleep”), chronic paresthesia may indicate an underlying medical condition requiring attention.

Medical coding: paresthesia in ICD-10

For medical documentation and billing purposes, paresthesia is classified under specific ICD-10 codes. The most common code is R20.2, which refers to “Paresthesia of skin.” Other related codes may be used depending on the cause and specific presentation.

General information

Paresthesias of skin are among the most common sensory disturbances. They are typically felt on the skin, less often – on the mucous membranes of the oral cavity and pharynx. In healthy people, they occur briefly after a blow or compression of a body part with impaired blood supply (more often – when sleeping in an uncomfortable position), disappearing within a few minutes. Along with hypo- and hyperesthesia, dysesthesia and hyperpathia, they are observed in neuropathic pain syndrome. Possible causes of the symptom include:

• Diseases of peripheral nerves: mononeuropathies, tunnel syndromes, polyneuropathies, plexitis, ganglionitis, ganglioneuritis, neuralgias.
• Central nervous system damage: spinal and craniocerebral injuries, tumors, circulatory disorders.
• Other neurological pathologies: migraine, Ekbom syndrome.
• Diseases of peripheral vessels: erythromelalgia, Raynaud’s syndrome, varicose veins, obliterating endarteritis, atherosclerosis and thromboangiitis.
• Dental diseases: glossodynia, xerostomia, glossitis.
• Metabolic disorders: hypoparathyroidism, vitamin B1 deficiency.
• Mental disorders: hysteria, depression, neurasthenia, pharyngeal neurosis.

Why this symptom occur

Neuropathies

These are diseases of multifactorial etiology that develop after injuries, with nerve compression, and in diseases of the musculoskeletal system (arthritis, tendinitis, exostoses). They manifest with muscle weakness, pain, and paresthesias. In late stages, numbness develops, and contractures form. The location of the sensory, autonomic, and motor disturbances is determined by the affected nerve trunk. When the upper limb is involved, the following nerves may be affected:

• Ulnar nerve.

Numbness occurs in the hypothenar area and 4-5 fingers. Weakness of the hand is noted when attempting to grasp an object. Symptoms often intensify in the morning.

• Median nerve.

Hypoesthesia and paresthesias are found on the radial side of the palm, partially in the projection of the fingers. Patients are concerned about severe pain. Movements of the 1-3 fingers are difficult. A variety of damage to this nerve is carpal tunnel syndrome, accompanied by frequent nocturnal pain attacks.

• Radial nerve.

Sensory disturbances spread to the shoulder, back of the forearm, and fingers 1-3. Muscle hypotrophy and “wrist drop” are detected.

Along with the above signs, when the legs are affected, characteristic changes in gait are often observed. The topography depends on the involved nerve:

• Sciatic nerve.

The leading symptom is ischialgia – shooting or burning pain along the back of the leg. Paresthesias are localized in the foot and posterolateral surface of the lower leg.

• Femoral nerve.

Paresis of the quadriceps is detected. Patients experience difficulties when running and walking. Sensitivity disorders encompass the inner edge of the foot and the anteromedial surface of the leg throughout its length.

• Lateral cutaneous nerve of the thigh.

Sensory disturbances are central to the clinical picture. Numbness and paresthesias occur in certain areas along the lateral side of the thigh, spreading to the entire outer and partially anterior surfaces.

• Tibial nerve.

Rising on tiptoe is impossible. Disorders of pain and tactile sensitivity are determined on the lower leg. In tarsal tunnel syndrome, burning pain develops in the sole. In calcanodynia, pain, paresthesias, and numbness disturb the heel area.

• Peroneal nerve.

Characteristic features include steppage gait and neuropathic pain along the anterolateral side of the lower leg and dorsum of the foot.

Plexitis

These occur after traumatic injuries, birth injuries, with tumors, lymphadenitis, and infectious diseases. They are more often unilateral. They manifest with spontaneous pain that intensifies with pressure in the projection of the nerve plexus. With progression, paresis develops, paresthesias increase, transitioning to hypoesthesia and numbness. The outcome is recovery (often incomplete). The symptom is provoked by the following types of plexitis:

• Cervical. Pain in the neck is noted, radiating to the ear and occiput. Torticollis is possible.
• Brachial. In the total form, pain, paresthesias, and muscle atrophy encompass the entire limb; in the lower and upper forms, the arm is partially affected.
• Lumbar. Neuropathic pain in the lower back radiates to the buttock and anterior surface of the thigh.

Ganglionitis, ganglioneuritis

Inflammation of the nerve ganglion and adjacent nerve trunks is characterized by paroxysmal diffuse burning pains without clear localization lasting from several minutes to several hours, autonomic disturbances, and various sensory disorders: paresthesias, hypoesthesia, hyperesthesia. The symptom is observed in the following ganglionitis and ganglioneuritis:

• Pterygopalatine ganglion. Patients are troubled by spontaneous pain attacks in the area of the eye, base of the nose, upper jaw, and hard palate, spreading to the neck, occiput, ear, and temple. Half of the face reddens, and abundant salivation and lacrimation are revealed.
• Otic ganglion. Typical are vegetalgias in the ear zone and in front of the external auditory canal, radiating to the neck, shoulder, and occiput. Ear congestion and hypersalivation are possible.
• Sublingual and submandibular ganglia. Pain is localized under the jaw, in the tongue and sublingual area, radiating to the occiput, temple, neck, and shoulder. Swelling of the tongue, hypersalivation, and less commonly, xerostomia are detected.

In cervical ganglioneuritis, pain and paresthesias appear in the face, head, arm, and upper chest; in thoracic ganglioneuritis, they appear in the chest. Lumbar and sacral ganglioneuritis are characterized by the spread of symptoms to the abdomen and lower limb.

Neuralgias

Patients are concerned about short-term paroxysms of shooting pain, similar to an electric shock. Paresthesias, as a rule, are not pronounced, observed in the inter-attack period, and accompany the following neuralgias:

• trigeminal neuralgia – prosopalgia covers half of the face;
• occipital neuralgia – involves the entire occiput or half of it;
• intercostal neuralgia – “shooting pains” are noted along the intercostal space.

Polyneuropathies

In most cases, upper and lower extremities are symmetrically affected, symptoms spread from distal to proximal parts. Paresthesias, dysesthesias and hyperesthesia are detected, which subsequently are replaced by hypoesthesia. Flaccid paresis forms, reflexes decrease, vegetative-trophic disorders occur. The clinical picture of polyneuropathy varies somewhat depending on the etiology of the disease.

Alcoholic polyneuropathy manifests with paresthesias. Initially, the symptom occurs briefly after staying in an uncomfortable position, gradually progresses, supplemented by muscle weakness, formation of numbness zones in the form of “gloves” and “socks”. Lower extremities suffer more. In diabetic polyneuropathy, tingling, burning, and numbness are noted. Patients are troubled by dysesthesias, hyperesthesias, short-term cramps in the feet, toes and fingers. Trophic disorders develop.

Polyneuropathy of pregnancy forms acutely or subacutely. Paresis and sensory disturbances are exacerbated against the background of multiple vomiting during toxicosis. In acute inflammatory polyneuropathy (for example, in Guillain-Barré syndrome), flaccid tetraparesis plays a leading role in the clinical picture, paresthesias take a back seat. CIDP proceeds in several variants. Complete regression of symptoms, progressive or recurrent course are possible.

Myelopathies

The symptom is observed in such myelopathies as:

• Discogenic: disc protrusion, intervertebral hernia, formation of adhesions after trauma and operations on the spine.
• Compressive: dislocations, subluxations and compression fractures of vertebrae, spinal cord tumors, hemorrhages under the membranes (traumatic, iatrogenic).
• Post-traumatic: spinal contusions during spine injury, penetrating wounds, damage to roots by displaced bone fragments.
• Vascular: disorders of spinal circulation, insufficient nutrition of nervous tissue due to vascular hypoplasia, aneurysm, thrombosis, embolism, vasculitis, nodular periarteritis, atherosclerosis.
• Infectious: acute enteroviral transient myelopathy, AIDS, spinal epidural abscess, syphilitic myelopathy.

Other lesions of roots and spinal cord

Paresthesias accompany a number of diseases and conditions with incomplete interruption of the spinal cord or damage (irritation, compression) of individual nerve roots. They occur below the level of lesion in the corresponding innervation zone. In radiculitis at the initial stage, diffuse pain is observed, subsequently a picture of the radicular syndrome forms, hypoesthesia and muscle weakness join:

• Cervical radiculitis. Pain syndrome bothers in the area of the neck, upper arm and chest, paresthesias are detected in the distal parts of the limb.
• Thoracic radiculitis. The affected area encompasses the arm and chest.
• Lumbar radiculitis. Patients complain of pain and paresthesias in the foot, lower leg or thigh.

Acute transverse myelitis is often diagnosed in multiple sclerosis, can complicate autoimmune and infectious diseases. It debuts with neuropathic pain, which is joined by widespread sensory disorders. Both hyperesthesia and burning paresthesias, as well as lack of sensitivity are possible. The symptom can also be detected in spinal cord injuries, primary and metastatic neoplasms of the spinal cord.

Other neurological diseases

Considering the localization of the pathological process, sensory and motor disturbances appear in separate areas or in half of the body (left or right), may be combined with cerebellar and vestibular disorders, signs of cranial nerve damage, and other focal symptoms. Paresthesias are found in the following conditions:

• tumors – characterized by a gradual increase in neurological symptoms;
• transient cerebrovascular accidents – muscle weakness, numbness, and hypoesthesia are short-term, disappearing within 24 hours;
• stroke – the clinical picture forms suddenly, resulting in persistent signs of neurological deficit;
• traumatic brain injury – residual effects are detected in severe and moderate trauma: brain contusion, fractures of the vault and base of the skull, open injuries.

Paresthesias are central to the picture of restless legs syndrome. Strange sensations appear at night, deprive patients of sleep, forcing them to get up and move. They are localized primarily in the shins and feet, eventually spreading to the thighs, arms, and perineum. The symptom sometimes bothers migraine patients. It occurs on the affected side, more often in the temple area.

Angiotrophoneuroses

In Raynaud’s syndrome, paresthesias result from vasospasm, observed at the early stage of ischemic paroxysm, replaced by aching pains and distention. Patients with erythromelalgia are troubled by attacks of burning or scalding pain in the feet, hands, less often in the perineum, ears, or nose. Over time, pain episodes become more frequent and prolonged, accompanied by paresthesias, hyperesthesia, and hyperpathia.

Peripheral vascular disease

Paresthesias are a characteristic symptom of obliterating pathologies of peripheral vessels: endarteritis, atherosclerosis, thromboangiitis. They are combined with muscle cramps, chilliness, hypoesthesia, and intermittent claudication. The manifestation is also detected in late stages of varicose veins, supplemented by edema, pain, and trophic disorders.

Dental Diseases

Paresthesias of mucous membranes are detected in some dental diseases:

• Glossitis. The symptom appears in the initial stages, including discomfort and burning. The tongue is swollen, taste recognition is difficult. Eating and talking cause discomfort due to pain.
• Glossodynia. Paresthesias are considered the main manifestation of the pathology. Patients complain of crawling sensations, itching, tingling, the feeling of a hair on the tongue. Initially, unusual sensations are short-term, subsequently becoming constant.
• Xerostomia. Due to insufficient salivation, patients are concerned about burning and dryness in the mouth. Eating causes discomfort. Infectious complications often develop.

Other causes

Possible causes of paresthesias include:

• Infectious diseases. The symptom occasionally occurs with significant hyperthermia against the background of acute infections and severe local purulent processes (abscesses, phlegmons).
• Endocrine and metabolic diseases. Neurological manifestations form against the background of metabolic disorders. Polyneuropathy develops with vitamin B1 deficiency. Paresthesias and muscle cramps are detected in hypoparathyroidism.
• Mental disorders. In patients with hysteria, depression, and neurasthenia, paresthesias have no organic basis, developing within the framework of somatization of mental disorders. In pharyngeal neurosis, the symptom is determined in the affected area, supplemented by irritation and pain.

Types of paresthesia

Paresthesia can be categorized into two main types:

Temporary (Transient)

• Occurs briefly and resolves without treatment
• Typically caused by pressure on nerves
• Common examples include sitting in one position too long or sleeping on an arm

Chronic (Persistent)

• Lasts longer and may be constant
• Often indicates an underlying condition
• Requires medical evaluation and treatment

Common symptoms and manifestations

Paresthesia may present with various symptoms, including:

• Tingling sensations (paresthesia tingling)
• Numbness
• Burning feelings
• Prickling sensations
• Pins and needles
• Sensitivity changes

These symptoms can affect different body parts, with certain areas being more commonly involved.

Areas commonly affected by paresthesia

Feet and hands

The extremities, particularly the hands and feet, are frequent sites of paresthesia. This pattern often occurs due to peripheral neuropathy or compression of nerves along the pathway to these areas. Diabetes, vitamin deficiencies, and certain medications commonly cause this pattern of symptoms.

Skin

When paresthesia affects the skin (also called paraesthesia of skin), patients may experience hypersensitivity to touch or unusual sensations on the skin surface. This type can be particularly distressing as clothing or air movement may trigger uncomfortable sensations.

Tongue

Tongue paresthesia (or tongue paraesthesia) involves tingling, numbness, or burning sensations in the tongue. This specific manifestation can significantly affect eating, speaking, and quality of life. It may result from damage to the lingual nerve, vitamin B12 deficiency, or certain medications.

Scalp

Scalp paresthesia (scalp paraesthesia) presents as tingling, crawling, or prickling sensations on the head. Stress, anxiety, and tension headaches often contribute to this manifestation. Some patients report a “back head tingling sensation” or “paresthesia back of head” that can be particularly concerning.

Whole body

Some patients experience “body tingling all over,” “all over body tingles,” or “all over body tingling sensation.” This whole body tingling may indicate systemic conditions like multiple sclerosis, anxiety disorders, or certain medication side effects. When paresthesia affects multiple body regions simultaneously, it warrants prompt medical evaluation.

Diagnostics

Establishing the etiology of paresthesias is under the supervision of a neurologist. If necessary, patients are referred for consultations with other specialists: phlebologist, vascular surgeon, endocrinologist. For unusual sensations on the oral mucosa, a dental examination is recommended. The doctor determines complaints, studies the life and disease history. Finds out when paresthesias first appeared, how the symptom changed over time. For diagnosis clarification, a comprehensive examination is conducted:

Neurological examination

Includes testing of sensitivity, reflexes, muscle strength. The neurologist performs palpation of the affected area, assesses tenderness at nerve exit points. Pain perception is tested with a needle, tactile – with cotton or a feather. Various functional tests are used to examine muscle strength and detect specific signs of various pathologies.

Electrofunctional methods

Include electromyography, electroneurography, somatosensory, trigeminal and skin evoked potentials. Indicated for neuropathies, plexitis, ganglioneuritis, trigeminal neuralgia, etc. They make it possible to confirm damage to the nerve trunk, establish its acuteness and localization, assess deep sensitivity and the functional state of the autonomic nervous system.

Neuroimaging

Magnetic resonance imaging is considered the most informative technique; CT is used less frequently. Depending on the suspected pathological process, the patient may be prescribed MRI of cranial nerves, brain or spinal cord. The methods make it possible to clarify the nature of the disease (tumor, hemorrhage, etc.). With suspected vascular genesis of neurological symptoms, MR angiography is recommended.

Vascular studies

Indicated for varicose veins and obliterating diseases. Ultrasound techniques are used (duplex scanning, Doppler ultrasonography). Peripheral arteriography, thermography, rheovasography, oscillography, capillaroscopy may be performed. To detect vascular spasm in arterial lesions, functional tests are performed (paravertebral or pararenal blockade).

Laboratory analyses

To clarify the etiology of polyneuropathies, toxicological studies, genetic tests, antibody analyses, and blood sugar determination are performed. In metabolic disorders, levels of vitamins, parathyroid hormone, phosphorus and calcium are assessed. In infectious diseases, microbiological examination, PCR, ELISA are performed. Morphological analysis is conducted to determine the type and degree of malignancy of neoplasms.

For lesions of hard structures, tunnel syndromes, radiological techniques are recommended (radiography, CT). For mental disorders, psychiatric consultation, psychological testing, and pathopsychological examination are indicated.

Treatments and management

Treatment approaches for paresthesia depend on the underlying cause:

Treating underlying conditions:

• Managing diabetes
• Addressing vitamin deficiencies
• Treating autoimmune disorders
• Modifying medications that cause paresthesia

Medication options:

• Anti-seizure medications (gabapentin, pregabalin)
• Antidepressants (amitriptyline, duloxetine)
• Pain relievers
• Topical treatments (lidocaine, capsaicin)
• Corticosteroids (for inflammation)

Conservative therapy

For diseases accompanied by paresthesias, the following therapeutic measures are conducted:

• Elimination of neuropathic pain. For intense pain syndrome, narcotic and non-narcotic analgesics, antispasmodics, tricyclic antidepressants, tranquilizers, and sedatives are prescribed. Nerve and trigger point blocks provide quick relief.
• Etiopathogenetic therapy. Depending on the cause of the disease, may include adjustment of insulin therapy, calcium preparations, vitamin B1, ganglionic blockers, adrenergic blockers, detoxification, administration of human immunoglobulin, and other methods.
• Other techniques. Neurotrophic drugs, ATP, vitamins B, C, PP are indicated. Good results are achieved with physiotherapy procedures. Physical therapy, massage, reflexology, galvanization, ultraphonophoresis, and inductothermy are used. Manual techniques are sometimes applied.

Surgical treatment

Depending on the cause of paresthesia, the following operations may be performed:

• Neuropathies: decompression, neurolysis of peripheral nerves, excision of nerve trunk tumors.
• Trigeminal neuralgia: microvascular decompression of the trigeminal nerve root, percutaneous rhizotomy.
• Ganglionitis, vascular diseases: cervical, thoracic, lumbar, or periarterial sympathectomy.
• Myelopathy, radiculitis: neoplasm excision, discectomy, microdiscectomy, puncture disc decompression, facetectomy, laminectomy.
• CNS lesions: transcranial, endoscopic, or stereotactic removal of hematomas, decompressive craniotomy, excision of neoplasms, thrombolysis for ischemic stroke.

Alternative treatments

• Acupuncture
• Massage therapy
• Transcutaneous electrical nerve stimulation (TENS)
• Relaxation techniques
• Biofeedback

Is there a cure?

While patients often search for a “cure for paresthesia,” treatment success depends on the underlying cause. In cases where paresthesia results from a reversible condition—such as vitamin deficiency or pressure on a nerve—complete resolution may be possible once the cause is addressed.

However, for chronic conditions like diabetes or multiple sclerosis, the goal is typically symptom management rather than complete cure. In these cases, a combination of medical treatments and self-care strategies can significantly improve quality of life.

When to see a doctor?

Seek medical attention if you experience:

• Sudden onset of paresthesia, especially on one side of the body
• Persistent symptoms lasting more than a few days
• Progressively worsening symptoms
• Paresthesia accompanied by weakness, coordination problems, or pain
• Symptoms affecting daily activities
• Whole body tingling without obvious cause

Self-care strategies

For ongoing management of paresthesia symptoms:

• Take medications as prescribed
• Follow treatment plans for underlying conditions
• Use proper ergonomics
• Take breaks from repetitive activities
• Apply heat or cold as recommended

Remember that paresthesia is a symptom, not a disease itself.