What Is the Difference Between Paresthesia and Dysesthesia?

Paresthesia is caused by pressure placed on a nerve. Dysesthesia is caused by nerve damage.

Both paresthesia and dysesthesia describe abnormal nerve sensations. 

Paresthesia describes abnormal burning or prickling sensations that are usually felt in the arms, hands, legs, or feet, but may also occur in other parts of the body. The sensation is usually painless and may be described as tingling, numbness, skin crawling, or itching. 

Temporary paresthesia is common and often described as “pins and needles,” such as when a person falls asleep on an arm or sits too long with legs crossed. Chronic paresthesia can be a symptom of an underlying neurological disease or traumatic nerve damage.

Dysesthesias are types of chronic nerve disorder that can also affect the arms, hands, legs, or feet, and feel like prickling, burning, stabbing, ice-cold, or electrical sensations. Dysesthesias can interfere with daily activities, sleep, and quality of life.

Symptoms of paresthesia and dysesthesia are both usually felt in the arms, hands, legs, or feet. 

The main difference between the sensations of paresthesia and dysesthesia is the severity. 

Paresthesia is usually painless, may be temporary such as “pins and needles” or chronic, and sensations may be described as:

• Tingling
• Numbness
• Skin crawling
• Itching

Dysesthesia is chronic and often painful, and sensations can interfere with daily activities, sleep, and quality of life. Dysesthesia may be described as:

• Prickling
• Burning
• Stabbing
• Ice cold
• Electrical sensations
• Pain with only light touch
• Cold feels hot or hot feels cold 

Temporary paresthesia is common and may be referred to as "pins and needles." This is caused by pressure placed on a nerve, such as when a person falls asleep on their arm or sits too long with legs crossed. When the pressure is relieved, the sensation goes away. 

Chronic paresthesia can be a symptom of an underlying neurological disease or traumatic nerve damage such as:

• Central nervous system disorders
• Stroke and transient ischemic attacks (TIAs, or mini-strokes)
• Multiple sclerosis
• Transverse myelitis
• Encephalitis
• Tumors or vascular lesions pressed up against the brain or spinal cord 
• Nerve entrapment syndromes, such as carpal tunnel syndrome

Dysesthesia is caused by nerve damage. Conditions that cause nerve damage and dysesthesia include:

• Autoimmune disorders
• Multiple sclerosis
• Acute inflammatory demyelinating polyneuropathy 
• Diabetes
• Lyme disease
• Drug or alcohol withdrawal
• Peripheral neuropathies
• Certain types of stroke (thalamic infarct)
• Chemotherapy

Paresthesia and dysesthesia are diagnosed based on the patient’s medical history and a physical examination, and after dermatological (skin) disease has been ruled out.

Blood tests to diagnose causes of paresthesia and dysesthesia may include

• Glycosylated hemoglobin (HBA1c)
• Complement (C3, C4)
• Antinuclear antibody (ANA)
• Antineutrophil cytoplasmic antibodies (ANCA)
• Antibodies to Borrelia burgdorferi (found in Lyme disease)
• Human immunodeficiency virus (HIV) 
• Viral hepatitis
• C-reactive protein (CRP)
• Iron, folate, vitamin B12, vitamin E
• Heavy metal levels
• Angiotensin-converting enzyme (ACE)

Other tests to diagnose causes of paresthesia and dysesthesia may include

• Skin biopsy
• Nerve conduction studies 
• Cerebrospinal fluid (CSF) analysis 
• Magnetic resonance imaging (MRI) of the brain and cervical spine 
• X-rays of the cervical/thoracic spine

Treatment for paresthesia and dysesthesia depends on the cause, where on the body the sensations are located, and the severity of symptoms.

Medications to treat paresthesia and dysesthesia may include:

• Capsaicin cream
• Local anesthetic patches
• Antidepressants
• Antiepileptics 
  • Gabapentin
  • Pregabalin
  • Carbamazepine
• Topical amitriptyline 1% with ketamine 0.5% for forearm itching  
• Antipsychotic medications 
  • Venlafaxine
  • Pimozide
• Propranolol
• Cannabinoids 

Other treatments for paresthesia and dysesthesia may include:

• Physiotherapy
• Physical barriers to reduce scratching and rubbing, such as gloves, night-time thermoplastic facemask, and night-time arm splinting
• Transcutaneous electrical muscle stimulation (TENS)
• Narrow-band ultraviolet radiation
• Botulinum-A injections 
• Intralesional steroid injections 

A complication of dysesthesia is decreased quality of life, impact on daily activities and sleep, and impact on mood and mental health.