Odd Nerve Sensations in Fibromyalgia and Chronic Fatigue Syndrome

doctor examining a wrist in pain
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Paresthesia is the medical term used to describe odd, but not usually painful sensations including tingling, crawling, itching, numbness, and prickling.

These sensations can be mild, somewhat annoying, uncomfortable, or, in people with fibromyalgia, even quite painful. Some people describe them as an annoying tickle or a hair brushing against their skin. Others may experience a sensation similar to the "pins and needles" of a foot that's "fallen asleep" due to restricted blood flow, or bugs crawling under the skin.

Paresthesias often come and go rather than being a constant sensation. They can strike without warning, usually without an obvious trigger. 

While these sensations are most common in the extremities—your feet, hands, and face—they can be present anywhere in the body.

Paresthesias in Fibromyalgia and Chronic Fatigue Syndrome

Fibromyalgia and chronic fatigue syndrome are both associated with paresthesias, including the painful kind. They can be of any severity and get more or less painful over time.

In chronic fatigue syndrome, we have no real research on paresthesias but a wealth of anecdotal reports. As in fibromyalgia, they can range from mild to severe and can show up just about anywhere.

In fibromyalgia, this symptom is firmly established by research as well as by anecdotal reports from people with the condition.

A 2009 study suggested that people with fibromyalgia who also smoke cigarettes tend to have more severe pain from paresthesias. (This is just one of several fibromyalgia symptoms that smoking may exacerbate.) Quitting smoking may help alleviate the pain, as well as other smoking-related symptoms.

A 2012 study suggests that carpal tunnel syndrome (CTS) is more common in people with fibromyalgia than in the general population. CTS is a painful and potentially debilitating condition that involves nerve compression and/or swelling in the wrist. It's especially common in people who spend a lot of time on the computer or playing video games, and in checkers at the grocery store.

The researchers who found this link warned that CTS can be hard to spot in people with fibromyalgia because the pain can be mistaken for paresthesias.

If you have fibromyalgia and pain in your hands, especially nerve pain or nerve "zings," and especially if they get really bad when you're asleep or trying to sleep, you may want to ask your doctor to check for CTS. Left untreated, it could get significantly worse over time.

Causes of Paresthesias

Paresthesias are most often caused by damage to peripheral nerves (those in the arms and legs) or pressure on those nerves, which may be caused by inflammation or injury. They can also be caused by chemotherapy drugs. However, most of the time the cause is unknown.

In fibromyalgia and chronic fatigue syndrome, one hypothesis is that they're the result of generally heightened sensitivity of the nerves as well as an amplified pain response in the brain. However, with further research, more possibilities are arising.

Chronic fatigue syndrome is believed to be associated with inflammation, which is a potential cause of the paresthesia. Fibromyalgia was long believed not to involve inflammation, but research has found evidence suggesting low levels of inflammation in the connective tissue called the fascia. That raises the possibility that inflammation may at least contribute to paresthesias in this condition.

Another more recent line of inquiry involves damage to small nerve fibers, which are in your skin, organs, and the nerves of your arms and legs (peripheral nerves). Their job is to provide sensation for your skin, such as when you touch something, and to control the function of your autonomic nervous system. That includes all of the automatic things, such as regulating heart rate, breathing, and body temperature. Damage to these nerves is called peripheral neuropathy.

Treating Paresthesias

When paresthesias aren't painful or disruptive, they're not something that needs to be treated. When they are painful, there are several treatment methods.

Some options for peripheral neuropathy are already used to treat fibromyalgia, including Lyrica (pregabalin) and Neurontin (gabapentin).

The doctors most likely to understand paresthesias and how to treat them are neurologists and rheumatologists.

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