Ask the Expert: Is that "Pins and Needles" Sensation Caused by Inflamed Nerves?
Thien Nguyen, MD
Most people have had a limb “fall asleep” from time to time, which usually goes away with movement. However, if you’re experiencing “pins and needles”, numbness or burning frequently in your arms legs, you may have polyneuropathy. Board-certified neurologist Thien Nguyen, MD answers your questions about this condition and what can be done about it.
My husband has just been diagnosed with polyneuropathy, but we still aren’t quite sure what it is. Can you give me an explanation?
Simply put, polyneuropathy is the loss or damage of peripheral nerves (the nerves that connect your brain and spinal cord to the rest of your body), which causes sensation or strength to be lost or impaired in certain parts of the body – usually arms, legs, hands and feet. People also tend to have a sensation of pins and needles.
My dad has polyneuropathy. What causes it? Should I be worried about getting it too?
Polyneuropathy has a wide variety of causes such as diabetes, critical illness, amyloidosis (the buildup of amyloid proteins in the heart, kidneys, liver or other organs), vitamin deficiency, hypothyroidism, Lyme disease and autoimmune diseases. Toxic exposure (i.e., alcohol, chemotherapy exposure, or most heavy metals), environmental exposure (i.e., vibration-induced nerve damage, prolonged cold exposure, lightning or hypoxemia) and HIV are also causes of polyneuropathy. It can be inherited (i.e., Charcot-Marie-Tooth (CMT) disease, etc.) and can also arise for no specific reason.
Sometimes I am not sure if my tingling and numbness is normal or not. What are the symptoms of polyneuropathy?
Polyneuropathy is typically characterized by numbness in arms and/or legs, a burning sensation, or weakness. Patients with small fiber polyneuropathy often have tingling, numbness, burning sensation, brief electric shock-like pain or, more rarely, an itchy sensation in the feet and legs. This may also involve autonomic dysfunction, which is when nerves are damaged.
While large fiber polyneuropathy may cause numbness and tingling in the feet and legs, it also causes a falls and abnormality in walking.
My podiatrist told me polyneuropathy needs a multidisciplinary treatment. What is a neurologist’s role in the treatment plan?
A neurologist helps to confirm the diagnosis of polyneuropathy, determine the cause of the polyneuropathy (if possible), and prevent further progression of polyneuropathy or recommend a course of treatment to help with symptoms caused by polyneuropathy.
What is the process of figuring out the type of neuropathy I have? Is there a test physicians do?
The patient’s history and examination are very important. We can determine a lot from the nature of the sensory loss -- motor predominance, if there’s asymmetry with the nerve loss and the rate of progression are examples of a few. Additional tests may also be very helpful, including electro-diagnostic testing with electromyography and/or nerve conduction studies (EMG/NCS), blood tests and skin biopsy. Autonomic testing can also be valuable; this included a variety of tests to determine neuropathy such as breathing, tilt table (which measures weakness or dizziness when sitting up) or gastrointestinal tests.
My primary care physician said there isn’t anything I can do for my diabetic neuropathy. Is this true?
Yes and no. Once a nerve is lost, we cannot bring back the nerve or the sensation that has been lost. However, there are a few things that may be helpful in managing diabetic neuropathy:
- Very good control of diabetes may slow down the rate of progression of diabetic polyneuropathy.
- We usually recommend combining good glucose control with foot care. On a daily basis, patients need to inspect their feet for the presence of dry or cracking skin, ulcers, plantar callus formation and signs of early infection between the toes and around the toe nails. Regular foot examinations help to avoid infection and complication.
- We can assist in alleviating pain that may occur in some patients with diabetic polyneuropathy.
- We can help with the patient’s gait and avoidance of falls.
I’ve started to lose balance and fall during some activities, probably due to my polyneuropathy. Is it too late to seek help?
No. We may be able to slow the rate of progression or stop the progression of the polyneuropathy if we identify a correctable cause for the polyneuropathy.
Even in cases where we cannot stop the progression, we can help you to walk more safely. I often have discussions with patients about the mechanism of walking and how to avoid falls, combined with physical therapy to assist with gait safety. In my experience, these things can provide a significant impact on your ability to walk or to do things more safely.
I don’t have diabetes, but I have the “pins and needles” feeling in my legs. I got a negative result from an EMG and nerve conduction test. Could it still be neuropathy?
You can still have polyneuropathy with a normal EMG nerve conduction study. EMG nerve conduction studies can only assess large fiber polyneuropathy. Small fiber cannot be evaluated by EMG nerve conduction study, but it may be assessed by skin biopsy. Small fiber polyneuropathy may cause tingling sensations, pins/needle sensations, burning sensations and sharp, brief, electric shock-like pain.
What are my treatment options for polyneuropathy? Are there any drugs on the market that I can take to make my nerves grow or stop the process of them dying?
First, we would try to identify and treat correctable causes. We also try to identify dangerous causes such as lymphoma, diabetes or eosinophilic granulomatosis with polyangiitis, which is a rare autoimmune disease, so that they can be treated by other specialists if needed.
However, there are many cases where the causes may not be known. While we may not be able to stop or slow the progression of it in these cases, we may be able to help with pain or other symptoms. As of now, there isn’t a medication to promote nerve growth or to prevent nerves from dying.
What is the process that a physician would take to decide how to treat my mother’s polyneuropathy?
Usually, I would obtain a careful history so that I can determine the possible causes. This may be followed by additional studies including electro-diagnostic testing with electromyography and/or nerve conduction studies (EMG/NCS), laboratory/blood tests, skin biopsy and autonomic testing.
My mom can’t walk anymore because of her neuropathy. Is there anything else we can do for her?
It is unlikely that we can help your mother to walk again. We might be able to get physical therapy to assist her with standing for a brief period, walking a short distance and transferring from a chair to bed or to a car.
I have polyneuropathy; is there anything I can tell my children to do to prevent them from getting it as well?
It depends on the causes of your polyneuropathy. Many causes are not inherited and therefore, would not impact your children. However, if you have an inherited polyneuropathy, your children may develop it as well.
My daughter has been showing symptoms of polyneuropathy, but she is only 15-years-old. Is it possible that kids can get polyneuropathy also?
Yes. Though polyneuropathy is somewhat uncommon in children, it can develop in children with inherited polyneuropathy, toxic exposure, infection or other processes.
Dr. Nguyen sees patients at Potomac Neurology located at 15200 Shady Grove Rd #202, Rockville, MD 20850. Call 240-477-5973 to make an appointment.