Pins and Needles: Why It Happens and When to Worry

What causes the pins and needles feeling

Nerves carry signals from the skin to the brain. When a nerve is squeezed, starved of blood or irritated, its signals are disrupted. When pressure is released, the nerve fires erratically as it recovers, producing the familiar prickling. Long-term nerve damage can produce constant tingling because damaged nerves send spontaneous signals.

Temporary pins and needles

The everyday kind comes from:

• sitting cross-legged or on your feet
• sleeping on an arm
• leaning on your elbows (the ulnar nerve)
• tight shoes, socks or watch straps
• cold

It clears within a few minutes of moving and is harmless.

Persistent or recurring pins and needles

Trapped nerves

• Carpal tunnel syndrome: tingling in the thumb, index and middle fingers, often waking you at night.
• Cubital tunnel syndrome: tingling in the ring and little fingers.
• Pinched nerves in the neck or back: tingling down the arm or leg with neck or back pain. Sciatica is a common example.
• Meralgia paresthetica: tingling and burning on the outer thigh.
• Tarsal tunnel syndrome: tingling in the sole of the foot.

Peripheral neuropathy

Peripheral neuropathy causes tingling, burning and numbness, usually starting in both feet. Causes include:

• diabetes, the most common cause
• vitamin B12 deficiency
• heavy alcohol use
• chemotherapy and some antibiotics and HIV medicines
• underactive thyroid and kidney disease
• too much vitamin B6 from supplements

Brain and spinal cord causes

• Multiple sclerosis: tingling or numbness that develops over days, sometimes with electric shocks down the spine when bending the neck.
• Stroke and TIA: sudden one-sided tingling, usually with other symptoms.
• Migraine aura: tingling that spreads gradually from the hand up the arm to the face over 5 to 20 minutes, followed by headache.
• Spinal cord compression.

Anxiety and over-breathing

During panic attacks or anxiety, fast breathing lowers carbon dioxide in the blood. This causes tingling in both hands, the feet and around the mouth, often with lightheadedness and chest tightness. It fades as breathing slows.

Body chemistry

• Low calcium (hypocalcemia): tingling around the mouth and in the fingers, with muscle cramps or spasms. It can follow thyroid or parathyroid surgery.
• Low or high potassium, and low magnesium.

Other causes

• Raynaud's phenomenon: tingling and numbness in cold fingers that change color.
• Shingles: tingling or burning in a band on one side of the body for a few days before the rash.
• Guillain-Barre syndrome: tingling in the feet and hands followed by rising weakness, days to weeks after an infection.
• Lyme disease, HIV and syphilis.
• Medicines such as some chemotherapy drugs, and the dental anesthetic wearing off.

Pins and needles all over the body

Widespread tingling is most often caused by anxiety and over-breathing. Other causes include peripheral neuropathy affecting many nerves, B12 deficiency, low calcium, multiple sclerosis, fibromyalgia, side effects of medicines, and the skin sensitivity that sometimes comes with viral illnesses. Tingling with burning headaches and widespread body sensations can occur with migraine, anxiety, fibromyalgia and some viral infections. Persistent widespread tingling needs a medical review with blood tests.

How doctors find the cause

A doctor will ask where the tingling is, whether it is on one or both sides, how long it lasts and what triggers it, and about other symptoms, diabetes, alcohol, diet, medicines and anxiety. They will check sensation, strength, reflexes and pulses.

Common tests include:

• blood glucose and HbA1c
• vitamin B12, folate, thyroid function, kidney and liver function, calcium and electrolytes
• nerve conduction studies and EMG
• MRI of the spine or brain when a central cause is suspected

Treatment and home care

• Move and shake out a limb that has fallen asleep.
• Avoid pressure: do not lean on elbows or cross legs for long. Loosen tight footwear.
• Wrist splints at night for carpal tunnel syndrome.
• Slow breathing for anxiety-related tingling: breathe in through the nose for 4 seconds and out for 6.
• Blood sugar control in diabetes.
• B12 supplements or injections for deficiency.
• Cut down on alcohol.
• Nerve pain medicines such as duloxetine, pregabalin, gabapentin or amitriptyline, prescribed by a doctor, can help painful, persistent tingling.

Frequently asked questions

What causes pins and needles?

Usually, temporary pressure on a nerve from sitting or lying awkwardly. Persistent pins and needles can come from trapped nerves like carpal tunnel syndrome, diabetes, vitamin B12 deficiency, alcohol, medicines, anxiety, low calcium or multiple sclerosis.

When should I worry about pins and needles?

Seek emergency care for sudden one-sided tingling with weakness, facial droop, speech or vision problems, or tingling that spreads up the legs with weakness. See a doctor if tingling keeps coming back, lasts more than a few days, or comes with numbness or weakness.

Can anxiety cause pins and needles?

Yes. Anxiety and panic can cause fast breathing, which changes blood chemistry and leads to tingling in the hands, feet and around the mouth. It usually settles within minutes as breathing slows. Tingling that persists or is one-sided should still be checked.

Why do I get pins and needles in my hands at night?

Night-time tingling in the thumb and first fingers is a classic sign of carpal tunnel syndrome, because wrists often bend during sleep. Sleeping with bent elbows can cause tingling in the little finger. Wrist splints and avoiding pressure on the elbows usually help.

Can vitamin deficiency cause pins and needles?

Yes. Vitamin B12 deficiency is a common, treatable cause of tingling in the hands and feet, often with fatigue and memory problems. Low folate, vitamin B1 and vitamin E can also contribute, and excess vitamin B6 from supplements can cause tingling.