Paresthesia suggests abnormality affecting the sensory nervous system and may arise anywhere from the peripheral nerve to the sensory cortex. Patients should be encouraged to use their own language, rather than trying to inject jargon, which may be ambiguous and fail to really convey what the patient is trying to describe. Paraesthesia is a technical term used to reflect a perception of abnormal sensation, including feelings of pins and needles, tingling, pricking or a feeling as if ants are crawling over/under the skin and patients should be encouraged to fully describe what they are feeling. Patients do not present with the complaint of ‘paraesthesia’ but will often complain of ‘numbness’ and it is imperative to determine if this means paraesthesia, before embarking on a diagnostic paradigm. The term ‘numb’ may mean abnormal sensation, including loss of feeling, tingling, pins and needles, electric shock-like sensations, a feeling of heaviness or loss of function, a loss of dexterity, or a host of other possibilities, depending on the individual patient. Patients will often volunteer vague terms, such as ‘numb’, and need help to tease out what they are describing. HistoryĪs is the case with all neurology, the most important diagnostic tool is a detailed comprehensive history that reflects what the patient is trying to convey. To offer maximal value and focus, the style adopted will be pragmatic, trying to offer some pearls, rather than offer a comprehensive treatise as is available in any standard text. Some of the investigations and management will be touched on but further consideration is reserved for the consultant.

It follows that this paper will, of necessity, be somewhat superficial, the goal being to assist GPs in their approach to patients with pareasthesia. The topic, for the preparation of this review, was to explore ‘paraesthesia and peripheral neuropathy’ with a focus on the needs of the general practitioner 9GP). Peripheral neuropathy is such a broad subject that it is impossible to do it justice in a brief overview such as this.

Testing for nerve damage in legs