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Dr. Mark Kestner: Tingling should be evaluated rather than ignored




This week we saw several patients that told me that they were concerned about some type of tingling.

One patient has tingling in his hands, alternating from side to side or sometimes both. Another had tingling and numbness in one hand only. Another had tingling and burning pain in both feet.

If you or someone close to you has ever experienced tingling in the hands or feet or other places this article is for you.

The answer to “What causes tingling?” is deceptively short. In most cases the cause is attributed to blood flow or more likely a neurological impairment. But the kinds of conditions that can lead to those simple causes number in the hundreds.

For this reason, it is important to not ignore tingling. It may be a sign of a serious malfunction of the body.

When I evaluate a patient whose complaints include tingling, I need to obtain the answers to a number of questions before beginning a diagnostic pursuit.

For example, in many cases of intermittent brief episodes of tingling in a hand or foot, questioning will quickly reveal the temporary cause that can be modified.

In many cases the solution is not that easy.

Here is just a partial list of potential causes for tingling sensation:

Nerve damage from injury, conditions such as diabetes, neurological conditions such as multiple sclerosis, nerve entrapment (pinched nerve) such as at the spine, shoulder, elbow, wrist, gluteal area, hip, knee, ankle, idiopathic peripheral neuropathy, muscular nerve entrapment, kidney disorder, liver damage, vascular damage or blood disorder, alcoholism, amyloidosis and connective tissue disorders, hormonal problems, hypothyroidism, tumors, swelling, spinal disc damage, spinal bone or joint damage, misaligned vertebrae, anemia, vitamin deficiencies, toxins such as heavy metals, environmental or industrial chemicals, medications, including some antibiotic and antiviral drugs, infections including Lyme disease, shingles, Epstein-Barre or HIV/AIDS virus, autoimmune diseases such as Guillain-Barre disease, lupus, rheumatoid arthritis, demyelinating polyneuritis, inherited disorders such as Charcot-Marie-Tooth disease and many more.

The majority of causes of tingling can be diagnosed accurately by a careful health history followed by appropriate physical examination and possibly imaging or lab studies.

For example, if a patient presents to me with a complaint of tingling in the feet, it is important to know if it is just one foot or both feet. Is the tingling accompanied by pain, weakness, change in color or other signs or symptoms? The answers to these questions will lead in the direction of a proper diagnosis. Certain neurological and orthopedic testing procedures will further refine the list of possibilities.

The details of the health history will give clues such as when the problem started, what affects it, recent changes in health status or medications, family history, other symptoms, what make it better or worse or other insights.

If the history and testing points to the possibility of a pinched nerve in the spine an MRI may be required to determine the exact cause of the impingement. Is the cause related to a damaged disc, a narrow bony canal, a tumor, swelling, recent injury of a joint structure or something else?

If the signs indicate that both extremities are involved it may be more likely that peripheral neuropathy is the diagnosis, but it is important to narrow down the cause of the neuropathy. Experts report that there are more than 100 types of peripheral neuropathy.

Some cases of tingling may require a visit to a neurological specialist for more involved testing. However, the majority of cases can be handled within the office.

Over the years we have encountered patients that are taking one or more of several typical drugs used for a variety of neurological disorders, such as gabapentin (Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta), nortriptyline or amitriptyline.

Expert opinions about these drugs vary. While one opinion may state something like, “Nortriptyline works well for symptoms of neuropathy (including tingling, burning, pain and numbness),” studies reveal fewer than 25% of patients that took nortriptyline for nerve pain reported at least a reduction of symptoms by 50%. That means that at least 75% of patients said it didn’t even reduce their symptoms by half.

In the same study, nortriptyline was referred to as the highest performing drug of the ones studied.

That’s pretty disappointing, really. If the best performing drug of the group only reduced symptoms effectively for less than 25% of the patients taking it, how lousy were the other drugs tested? (Short answer, pretty lousy.)

The other great concern is how well or how poorly the drugs are tolerated. It may not be a big surprise that the big “winner” of the test (nortriptyline) in effectiveness at less than 25% had the biggest problem with side effects.

It is not unusual for patients to be prescribed several different drugs for persistent tingling conditions. In many cases dosages are increased several times until the patient reports the side effects are too intolerable.

There are some new technological answers that can successfully address some causes of tingling and other neuropathy symptoms. In our office we have found success with a combination of several forms of technology as well as certain nutrition products.

Each case varies, however, so evaluation is required to determine the best recommendation.

Dr. Mark Kestner is a licensed chiropractic physician and acupuncturist with 30-plus years of experience focused primarily on treating complex and chronic spine, joint and neurological conditions in Murfreesboro. His office is at 1435 NW Broad St. Contact him at mkestner@DrKestner.com.

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