What Do Pins And Needles Signify?

Introduction 

Pins and needles, known through its clinical name as paraesthesia, is an abnormal sensation in the skin that can be described as either numbness, tingling or prickling. In healthy individuals under normal circumstances, this is associated with a temporary disruption in blood circulation such as sitting cross-legged for a prolonged period or lying on your arm while sleeping. Changing your position relieves this feeling as blood flow returns to normal.

Despite paraesthesia being fairly common, temporary and harmless, it can also be a singular symptom of something more complicated and serious.

Raynaud’s phenomenon

Raynaud’s phenomenon (or Raynaud’s syndrome) is a condition where the muscles within your arterioles (tiny arteries) spasm to cause prolonged vasoconstriction (narrowing of the blood vessel).¹ This leads to less blood flow and occurs in the extremities, i.e., areas furthest away from the heart such as your fingers, ears, nose and feet.

These body parts can turn white due to lack of blood flow, and even become blue if left longer since there is no haemoglobin transporting oxygen. These episodic colour changes, paired with feelings of coldness and numbness (or paraesthesia) are known as Raynaud’s attacks.

Raynaud’s is a rheumatic disease, meaning it mostly affects the joints. These typically occur in the hands since they are likely to be exposed to cold temperatures – one of the potential triggers for attacks. Since fingers feel stiff in the cold, combined with loss of sensation through paraesthesia, this can make hand coordination difficult.² Emotional stress (like anxiety) can cause attacks also, since hormones are involved, including those responsible for vasoconstriction.³

Luckily, if the skin is concealed or you move to a warmer environment, this can help revert symptoms. While no medication exists solely to treat Raynaud’s, you can be prescribed something to aid circulation and reduce the likelihood of attacks from happening.

Sciatica

The sciatic nerve is a major nerve that runs from the lower back and down the legs and is responsible for feeling sensations in the legs and feet. It is responsible for the innervation of leg muscle, meaning that any reflex responses involving the leg are mediated via the sciatic nerve.⁴

Sciatica occurs when the sciatic nerve is irritated or compressed. This results in feeling pins and needles, numbness or pain in your legs or feet. Thankfully these are as temporary as the irritations of the nerve. Discomfort may be constant or intermittent depending on the individual.⁵ While paraesthesia is mostly associated with a lack of blood circulation, in the case of sciatica, it is the interference of nerve impulses.

Fortunately, there are different measures you can take without medical intervention to relieve the sensory issues that come with sciatica. Regular, gentle exercise, especially involving the legs such as walking or squatting is recommended. You should also try to avoid sitting or lying down for prolonged periods (apart from sleeping, of course), as this can otherwise worsen your sensory issues.

If the paraesthesia, or other sensory issue, persists for more than a month, you should consult your doctor for further action. You can ask for painkillers if you feel like they would be beneficial, however doctors may believe anti-inflammatory medication to be more suitable. This, along with your symptoms, is different for everyone and professional advice should always be considered before taking any medication.

Sciatica is one example of radiculopathy, a category of conditions that are explained below.

Radiculopathy

The term radiculopathy refers to any irritation or compression to nerve roots, which are parts of nerves that split into multiple branches. If this occurs in larger, more central nerves, this affects a larger amount of your nerves that come after it. This is why, when the sciatic nerve is affected, any or all of your lower region is affected.

Radiculopathy can occur on nerve roots within different locations of the body:⁶

Lumbar radiculopathy 

Affects the back, legs and foot (sciatica is an example of this), including experiencing paraesthesia. 

Cervical radiculopathy 

Affects nerves that provide sensation to the neck and arms. 

The cause of radiculopathy differs depending on the case. Some can be induced by injuries such as whiplash (sudden, rapid movement on the neck) or potentially from some sort of collision. The nerves involved are not damaged but, instead, undergo abnormal stress or pressure. Nerve damage leads to more serious conditions such as loss of sensation or paralysis, which is not the case here.

Changes in bone growth can affect nerve roots, applying pressure and narrowing them. These bones are typically the vertebrae, the plates along the spine contain discs that may compress or irritate the nerves that pass through them. The ways in which these discs interact with your nerves may change over time, as will the pattern of your symptoms, although these are expected to be long-term. If these symptoms intensify or are persistent, it’s possible to require osteotomy as a surgical intervention (removal of part of the bone) to relieve compression on the nerves.⁷

Multiple sclerosis

Multiple sclerosis (MS) is a chronic condition characterised by the deterioration of myelin sheaths that surround your nerves. Myelin is a lipid-based substance that covers nerves to insulate electric impulses, ensuring they travel successfully across the body. In people with MS, nerve impulses are less likely to be transmitted successfully, creating a lack of sensation, loss of limb coordination and, as expected, paraesthesia.⁸

Regarding the sensory issues that come with MS, you can take certain medications called interferons which target the immune system. This is because myelin deterioration is believed to be due to an autoimmune response, whereby your immune system cannot correctly recognise itself and attacks.⁹ Taking these medications should prevent symptoms like paraesthesia from worsening.

People with MS may experience relapses in their respective symptoms. This is due to the body’s inflammatory response to the damage of myelin. Corticosteroids are used to prevent this from occurring. Lifestyle adjustments such as staying active, eating a balanced diet (particularly with increased vitamin intake) and limiting alcohol intake can also help this from occurring.

Carpal tunnel syndrome

Carpel tunnel syndrome (CTS) is a condition that can be categorised as neuropathy, the compression of nerves generally as opposed to only the roots (i.e., radiculopathy). In the case of CTS, the median nerve is compressed, which causes changes in sensation to the wrist, hand and fingers. These changes can be numbness, pain and also paraesthesia.¹⁰

The development of CTS is heavily influenced by certain physical activities, especially those as part of a job that requires a lot of repetitive tasks. Work that involves constant typing or writing at a desk can cause strain on the median nerve over time.¹¹

You can check if you have CTS by seeing if you have numbness or pain in your arms, but mostly in your fingers and hands. You may experience weakness in your thumb and therefore have difficulty in holding/gripping onto objects.

Symptoms tend to be worse at night as the hands tend to naturally bend when we are sleeping, which may put a strain on the median nerve. While paraesthesia is not necessarily an issue while asleep, the intense pain that could result from it during sleep may be strong enough to wake you up.

CTS is a common misdiagnosis for rheumatoid arthritis and tendonitis which affects the joints and tendons respectively. As these do not affect the nerves, paraesthesia is not an associated symptom.¹²

Diagnosis from pins and needles

As you can see from the above sections, a wide range of conditions have pins and needles as a symptom, so more information is required to identify the exact one you may have.

Before diagnosis, a doctor or any other medical professional needs to understand your medical history, especially any records of specific trauma (injury) that may coincide with the start of the symptoms like paraesthesia emerging.¹³

A range of neurological tests are required to assess the severity of the condition such as a spinal tap, whereby cerebrospinal fluid is extracted from the spine and then analysed.

Summary

Pins and needles are just one symptom of several different conditions – other signs should be observed before making guesses on which of these you may have. It is also not solely caused by an interruption of blood circulation.

While pins and needles are due to momentary changes to blood circulation in normal circumstances, when it is a symptom of a specific and more serious condition, it will typically involve the nervous system. Since paraesthesia is an abnormal sensation on the skin, nerve connections are still relatively intact, and merely undergo temporary stress. 

Generally, pins and needles are considered to be one of the less significant symptoms of a disease, as more life-changing ones could be present such as loss of motor function or paralysis.

If you believe that the pins and needles you are experiencing aren't just from a temporary disruption in blood circulation, it is recommended that you consult with a healthcare professional for a proper diagnosis.