Hyperesthesia

What is hyperesthesia?

Hyperesthesia is a symptom that involves extreme sensitivity in your sense of touch. Sensations that should feel light or easy to tolerate feel intense or even overwhelming. It often happens along with neuropathic pain (pain related to nerve dysfunction/damage).

An example of hyperesthesia is feeling unusually strong temperature sensations. If you have hyperesthesia and touch a warm cup of coffee or tea, you'll feel a flood of sensations related to the cup's warmth. It won’t hurt or feel like it’s burning you, but the feeling of warmth will be very difficult — if not impossible — to ignore or tune out.

This oversensitivity may extend to everything your tactile (touch-based) sense can pick up. Touch, temperature, pressure and pain will all feel much more intense than expected under ordinary circumstances.

Is hyperesthesia common?

Experts aren’t sure how common hyperesthesia is for several reasons:

• Hyperesthesia is subjective. What’s too intense for one person might not be for another.
• Hyperesthesia is individual-specific. How you experience your sense of touch is totally unique to you, and there’s no way to tell if someone else experiences their sense of touch the same as you do.

Why does hyperesthesia happen?

Hyperesthesia may indicate that your nervous system isn’t working properly. Under ordinary circumstances, your nervous system tries to regulate the intensity of the signals it sends and relays. The signals have to be strong enough for you to notice and process, but not so strong that they overwhelm your brain’s processing abilities. It tries to reserve more intense signaling only for when absolutely necessary (like the pain of touching something hot enough to burn you).

Hyperesthesia could happen when some part of the sensory process becomes dysfunctional. That can happen in the nerves themselves, your brain or your spinal cord. In effect, your sense of touch is dialed up to 11 without any regard for whether or not that level is necessary.

Sensitization

Your nervous system uses a combination of electrical and chemical signals to send and relay signals to and from your brain. Certain types of signals that happen too frequently or too intensely can alter the way your nervous system handles those signals. That’s called “sensitization,” and it usually involves pain signaling. When this happens, the nervous system cells that handle pain signals become too responsive to pain signals. Pain signals can become more intense, easier to trigger or may happen without a reason.

What are the most common causes of hyperesthesia?

Hyperesthesia can happen with any condition or circumstance that changes how your nervous system sends and relays touch and pain signals. Many processes can affect different parts of your nervous system, including your:

• Brain or spinal cord.
• Nerve roots.
• Cranial nerves.
• Peripheral nerves.

Common conditions of the nervous system that affect these processes are:

• Neuralgia (nerve pain) diseases, including occipital neuralgia, trigeminal neuralgia, glossopharyngeal neuralgia and nervous intermedius neuralgia.
• Opioid-induced pain syndromes (dysfunctional pain processing related to chronic opiate use).
• Peripheral neuropathy.
• Pinched nerves or radiculopathy.
• Spinal cord injuries.
• Stroke or transient ischemic attacks (TIAs).

Other non-nervous system conditions can affect sensory processing by causing dysfunction or damage to nerves. Examples of these conditions include:

• Metabolic or endocrine conditions, like:
  • Vitamin B12, B1, B6 and copper deficiencies.
  • Diabetes-related neuropathy (nerve damage).
  • Electrolyte imbalances.
  • Low parathyroid function (hypoparathyroidism).
  • Low thyroid function (hypothyroidism).
  • Thyroid disease.
    
• Infectious diseases, like:
  • Guillain-Barré syndrome.
  • Hansen’s disease (leprosy).
  • Hepatitis B and C viruses
  • Herpes simplex virus.
  • Herpes zoster virus (shingles).
  • Human immunodeficiency virus (HIV).
  • HTLVI I-II.
  • Lyme disease.
  • Syphilis.
  • West Nile virus.
    
• Autoimmune and inflammatory conditions, like:
  • Lupus.
  • Multiple sclerosis.
  • Rheumatoid arthritis.
  • Sjögren’s syndrome.
  • Vasculitis.
    
• Toxic sources, like:
  • Antibacterial/antifungal medications like isoniazid or metronidazole.
  • Arsenic poisoning.
  • Chemotherapy.
  • Lead poisoning.
  • Mercury poisoning.
  • Neuropathy from alcohol use disorder.
    

Other conditions, including:

• Cancers and paraneoplastic disorders.
• Central desensitization syndrome/fibromyalgia.
• Functional neurologic disorder.
• Amyloidosis.
• Multiple myeloma.
• Porphyria.
• Sarcoidosis.
• Somatoform disorder.

How is hyperesthesia treated?

A neurologist (a physician who specializes in disorders of your brain, spinal cord and peripheral nerves) should be able to localize the area of dysfunction and perform tests to find the root of the problem. They may get blood work, electrophysiologic studies (electromyography [EMG] and nerve conduction studies), neuroimaging studies (magnetic resonance imaging [MRI]), neuromuscular ultrasound and more.

Treating hyperesthesia is often complex because so many conditions can cause it and so many factors can contribute to it. Medications are common treatment options for symptom relief. These medicines are used for the treatment of neuropathic disorders:

• Tricyclic antidepressants, like amitriptyline and nortriptyline.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), like duloxetine and venlafaxine.
• Antiseizure medications, especially gabapentin, pregabalin, carbamazepine, oxcarbazepine andzonisamide and topiramate.
• Topical anesthetics, like lidocaine (with or without capsaicin).
• Painkillers, like tramadol. Less commonly, opioid painkillers may be an option.
• Onabotulinumtoxin A injections (commonly known under the brand name BOTOX®).
• Nerve blocks.

When should I worry about hyperesthesia or get it treated by a healthcare provider?

Hyperesthesia isn’t dangerous but can have a significant impact on your quality of life and cause mental health complications, especially anxiety and sometimes depression.

Chronic pain also has potential long-term effects that can seriously affect your quality of life. If you experience hyperesthesia, seeing a healthcare provider as soon as possible is important.

Can hyperesthesia affect other senses besides touch?

Yes, hyperesthesia can also happen with sound. The term for this is “auditory hyperesthesia.” If you have this, what you hear sounds much louder than expected. Other terms for this include “hyperacusis,” “sound intolerance” or “sound hypersensitivity” (seen in acoustic trauma, chronic ear infections, adverse reaction to medicines or procedures, Bell’s palsy and others).

Hyperalgesia vs. hyperesthesia — what’s the difference?

Hyperesthesia is when your sense of touch is overly sensitive. Hyperalgesia is when your sense of pain is overly sensitive. Having hyperalgesia means you experience pain that’s far more severe than expected.

Hyperesthesia and hyperalgesia both connect to neuropathic pain and other pain syndromes. They also connect to other symptoms like allodynia, which is when things that shouldn’t hurt cause pain, like brushing your hair or putting on clothes.

Other common terms used to describe sensory symptoms include:

• Dysesthesia: A condition in which a sense, especially touch, is distorted.
• Paresthesia: Altered sensations such as numbness or tingling.
• Allodynia: Pain due to a stimulus that shouldn’t cause pain.