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Often referred to as "pins and needles", the pain of circulatory
insufficiency is a curious kind of nociception, even in individuals without Central Pain,
where it is really a type of powerful paresthesia. In Central Pain there may be thalamic
release of paresthetic mechanisms, but the concept of a paresthetic "system"
separate from pain goes beyond current knowledge. The tingling of "pins and
needles" or impaired circulation may simply be a manifestation of hyperpathia, but a
separate category seems appropriate for the tingling which is common in Central Pain. Like
hyperpathia, it is not durable, but unlike hyperpathia, the tingling does not reach
overblown heights when evoked, even at levels of circulatory compromise which would result
in tingling in people without Central Pain.Similar to Central Pains upgrading of normal
muscle tone to painful cramping, changes in circulation which have no physiologic
significance have significance conferred upon them by Central Pain. "Pins and
needles" is so common and accompanies evoked dysesthesia so frequently that some
investigators mistake it for the characteristic sensation of Central Pain. The
patient may mention tingling because it is frequent and because it is not dysesthetic and
therefore the patient can discuss it, but it ranks low among the hierarchies of suffering.
This is not to say that the "pins and needles" sensation is not unpleasant. The
Central Pain patient may feel this nearly continually, while of course it stays dormant in
people without Central Pain until the impaired circulation is significant.
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The Mnemonic of
Central Pain