Sunday, July 10, 2016

Paresthesia - Definition, Types, Causes and Treatment

What is Paresthesia?

Definition : Paresthesia is the sensation of numbness or burning, or prickling, tingling or itching in the skin. It can also be described as a pins-and-needles or skin-crawling sensation. While paresthesia does occur in various body parts, it is most frequently seen in extremities. [1]

It may be as simple and as temporary as when your "foot falls asleep", which happens when pressure is applied to a nerve and relieved easily. Or it may be a symptom of a more serious underlying condition. [4]

Often it is seen as unexplained numbness in the big toe. Other times it is noted as a primary symptom of multiple sclerosis.

Paresthesia Symptoms

Notice not only the evident itching or numbness in the skin, but other accompanying symptoms which may suggest other conditions which cause the undetermined numbness. [3] It is important to diagnose the underlying condition that is causing the numbing sensations. This will determine what type of treatment will be best suited for the patient. Physicians may order additional tests depending on the suspected cause of the paresthesia. [4]

Types of Paresthesia

  • Transient

Paresthesia may be divided as either chronic or transient. Transient paresthesia can be caused by hyperventilation syndrome or even by a panic attack. It may be mild and temporary pressure on a nerve which is relieved when the pressure is removed.
  • Chronic

Chronic paresthesia causes are poor blood circulation, nerve injury or irritation, neuropathy, or many other conditions. [4]

Causes of Paresthesia

Paresthesia is related to many health conditions. Some are serious, yet, most are not. [2] Some of the common causes are noted here:
  • diabetes
  • fibromyalgia
  • peripheral neuropathy
  • multiple sclerosis
  • carpal tunnel
  • whiplash
  • Lupus
  • shingles
  • Some types of heart conditions
Chronic paresthesia is usually a sign of an underlying neurological disorder. When a nerve is inflamed or irritated or circulation to the nerve is impaired paresthesia may occur. Also as a result of athletic injuries or accidental trauma nerves may be damaged. Therefore it is important for the physician to consider these primary causes of paresthesia:
  • inflammation
  • irritation
  • circulation
  • trauma
In addition, this condition can be caused by conditions affecting the CNS (central nervous system), like transient ischemic attacks (mini-strokes) and strokes, multiple sclerosis, encephalitis and transverse myelitis. If a tumor is causing pressure on the spinal cord or brain, it can result in paresthesia.

This is also true for vascular lesions. Nerve entrapment syndromes, like carpal tunnel syndrome, can damage the peripheral nerves and lead to paresthesia along with pain. [6]

Paresthesia Diagnosis

Often, in addition to the patient's health history, a CT scan can be a helpful diagnostic tool. Also a nerve conduction examination can help focus the cause of the condition. [6]

Paresthesia Treatment

Topical creams such as lidocaine or prilocaine are effective at reducing the numbness, yet they can only offer temporary relief and they do does not affect the underlying cause. Take precautions here because it is an easy matter to use too much lidocaine too often. [6] Depending upon the underlying cause, prescriptions such as prednisone (an immunosuppressant) or gabapentin (an anticonvulsant) or antiviral medicines or intravenous gamma globulin (IVIG ) may be prescribed. For example, if paresthesia is cause by shingles, an anti-viral prescription is given. [6]

Paresthesia Prevention

With such a multitude of possible causes for chronic paresthesia, it is difficult to identify a particular course of action to prevent it from happening. Nonetheless, there are some common characteristics to consider.
  • Maintaining a healthy diet with adequate nutrition may prevent paresthesia which is precipitated by vitamin deficiencies.
  • Pay attention to medications being prescribed because some have side effects during administration and others, like SSRIs may exhibit paresthesia types of symptoms upon withdrawal.
  • Maintain an active physical life, exercise helps circulation, which can also aid in preventing numbness.
  • Avoid abusing drugs.

When To Call A Doctor

Contact your physician when:
  • the paresthesia symptoms continue for an extended period of time
  • when the condition worsens
  • when traumatic injury is known
  • function is limited
  • no relief is obtained from home remedies or topical creams
  • when other significant symptoms are present, such as vision or speech difficulties. [5]

Paresthesia ICD9 Codes

Often when a patient seeks medical attention there are questions regarding how to apply insurance codes to cover the ailment. These are called "icd9 codes". Since paresthesia can originate from multiple causes, the proper icd9 code is important for current and future insurance coverage for the patient.

Physicians need to remind their staff to use the proper codes and they need to clarify which ones are pertinent for each patient. [7]