Pins and Needles Abdomen: Causes & When to Worry

Pins and needles abdomen, medically referred to as paresthesia localized in the abdominal region, presents a unique diagnostic challenge requiring careful evaluation to determine the underlying etiology. Potential causes range from relatively benign conditions such as nerve compression due to posture or clothing to more serious systemic diseases. The diagnostic process may involve imaging techniques such as Magnetic Resonance Imaging (MRI) of the spine and abdomen to rule out structural abnormalities affecting nerve function. Furthermore, a comprehensive neurological examination, often guided by specialists at institutions like the Mayo Clinic, is crucial in differentiating between peripheral neuropathy and central nervous system disorders that could manifest as pins and needles abdomen. The sensation of pins and needles is often linked to disrupted nerve signals which can be caused by various conditions, including but not limited to shingles, diabetes, or even vitamin deficiencies.

Understanding Paresthesia: What Are Those Tingling Sensations?

Paresthesia: the unwelcome guest of sensation. This is characterized by abnormal skin sensations, such as tingling, prickling, or numbness. It's the body's equivalent of a crossed wire, often described as that familiar "pins and needles" feeling.

But what's truly happening beneath the surface? And why does our body betray us with these phantom sensations?

The Peripheral Nerve Network: Our Sensory Superhighway

To understand paresthesia, we must first appreciate the role of our peripheral nerves. Think of them as a vast sensory superhighway, tirelessly relaying information between our brain and the rest of our body.

They're responsible for transmitting an array of sensations, from the gentle touch of a breeze to the sharp sting of a burn. This intricate network allows us to interact with, and understand, our environment.

When the Signal Fades: The Root of Paresthesia

Paresthesia arises when this complex communication system is disrupted. Damage or dysfunction in the peripheral nerves can scramble the signals, leading to those strange and often uncomfortable sensations.

This disruption can stem from a variety of causes, ranging from simple compression to more complex underlying medical conditions.

Damage and Dysfunction Explained

Nerve damage can occur due to physical trauma, such as a direct blow or repetitive strain. Dysfunction, on the other hand, may be caused by underlying medical conditions that interfere with nerve function, such as diabetes or autoimmune disorders.

Whatever the cause, the resulting disruption in nerve signaling leads to the hallmark symptoms of paresthesia: the tingling, prickling, and numbness that can range from a minor annoyance to a debilitating chronic condition.

The Language of Paresthesia: Deciphering the Sensations

Paresthesia manifests differently from person to person. Some may experience it as a mild, transient tingling, while others suffer from persistent numbness that interferes with daily activities.

Understanding the specific characteristics of these sensations is crucial for identifying the underlying cause and developing an effective treatment plan. It is important to acknowledge that the severity of paresthesia depends on the extent of nerve damage or the underlying medical problem.

By understanding the intricacies of paresthesia, we can begin to unravel its complexities and pave the way for more effective diagnosis and treatment.

Medical Conditions Linked to Paresthesia: A Comprehensive Overview

Paresthesia, that unwelcome guest of sensation, rarely appears uninvited. This is characterized by abnormal skin sensations, such as tingling, prickling, or numbness. It's the body's equivalent of a crossed wire, often described as that familiar "pins and needles" feeling. But what's truly happening beneath the surface? This section explores the myriad medical conditions that can manifest as paresthesia, offering a comprehensive view of potential underlying causes.

Neuropathy: The Nerve's Lament

Neuropathy, in its broadest sense, refers to nerve damage, and it stands as one of the most frequent instigators of paresthesia. When nerves falter in their ability to transmit signals effectively, the result can be a cascade of abnormal sensations.

Peripheral Neuropathy: When the Extremities Suffer

Peripheral neuropathy specifically targets the nerves furthest from the brain and spinal cord—those extending into the hands and feet. Its prevalence is significant, affecting millions worldwide. Common causes include diabetes, autoimmune diseases, infections, and exposure to toxins.

Diabetic Neuropathy: A Consequence of Uncontrolled Blood Sugar

Diabetic neuropathy, a specific subset of peripheral neuropathy, warrants particular attention. It's a direct consequence of prolonged, elevated blood sugar levels damaging nerve fibers. The importance of meticulous blood sugar control in preventing or mitigating diabetic neuropathy cannot be overstated. Lifestyle modifications, medication, and vigilant monitoring are critical.

Autoimmune Diseases: The Body Attacking Itself

Autoimmune diseases, characterized by the immune system mistakenly attacking the body's own tissues, can also trigger paresthesia.

Multiple Sclerosis (MS): Demyelination and Sensory Disruption

Multiple sclerosis (MS), a debilitating autoimmune disorder, targets the central nervous system. It manifests paresthesia through the demyelination of nerve fibers. This process disrupts the efficient transmission of signals within the brain and spinal cord. The result is a range of neurological symptoms, including tingling, numbness, and pain.

Transverse Myelitis: Inflammation of the Spinal Cord

Transverse myelitis, another autoimmune condition, involves inflammation of the spinal cord. This inflammation can disrupt the normal function of nerve pathways, leading to paresthesia, weakness, and bowel or bladder dysfunction.

Infectious Diseases: Invading the Nervous System

Certain infectious diseases can directly or indirectly affect the nervous system, resulting in paresthesia.

Herpes Zoster (Shingles): A Reactivation of Varicella-Zoster Virus

Herpes zoster, commonly known as shingles, is a reactivation of the varicella-zoster virus, the same virus that causes chickenpox. After chickenpox resolves, the virus lies dormant in nerve tissue near the spinal cord and brain. When reactivated, it travels along nerve pathways to the skin, causing a painful rash and potential nerve damage that can lead to postherpetic neuralgia, characterized by chronic pain and paresthesia.

Lyme Disease: A Bacterial Invasion

Lyme disease, transmitted through the bite of infected ticks, can manifest neurologically if left untreated. The bacteria Borrelia burgdorferi can invade the nervous system, causing a range of symptoms, including paresthesia, nerve pain, and cognitive difficulties.

Other Potential Medical Conditions

Beyond neuropathy, autoimmune disorders, and infections, several other medical conditions can contribute to paresthesia.

Fibromyalgia: Widespread Pain and Sensory Amplification

Fibromyalgia, a chronic pain disorder, amplifies pain signals and affects how the brain processes pain. While not directly damaging nerves, it can significantly alter sensation, leading to widespread pain, tenderness, and paresthesia.

Vitamin Deficiencies: Nourishing the Nerves

Vitamin deficiencies, particularly of B12, D, and magnesium, can have profound neurological effects. These vitamins play crucial roles in nerve function. Deficiencies can lead to nerve damage and, consequently, paresthesia.

Spinal Cord Compression: A Threat to Neural Pathways

Spinal cord compression, resulting from injury, tumors, or degenerative conditions, can impinge upon the spinal cord, disrupting the flow of nerve signals. This can cause paresthesia, weakness, and bowel or bladder dysfunction.

Abdominal Wall Pain Syndromes: Hidden Source

Conditions like abdominal cutaneous nerve entrapment syndrome (ACNES) can result in chronic abdominal pain. This occurs due to the entrapment of sensory nerves within the abdominal wall, leading to paresthesia and localized pain.

Complications and External Factors

Paresthesia can also arise as a complication of medical procedures or due to external factors.

Post-Surgical Nerve Damage: An Unintended Consequence

Post-surgical nerve damage, though often unintentional, can occur during surgical procedures. Nerves may be stretched, compressed, or cut, leading to temporary or permanent paresthesia.

Medication Side Effects and Poisoning/Toxicity: External Threats

Certain medications can have side effects that include paresthesia. Furthermore, exposure to toxins, such as heavy metals or certain chemicals, can damage nerves and induce paresthesia.

Anatomy and Sensation: Key Components in Paresthesia

Paresthesia, that unwelcome guest of sensation, rarely appears uninvited. This is characterized by abnormal skin sensations, such as tingling, prickling, or numbness. It's the body's equivalent of a crossed wire, often described as that familiar "pins and needles" feeling. Understanding the anatomical structures and physiological processes that underlie normal sensation is crucial to unraveling the mysteries of paresthesia. When these intricately linked components malfunction, the resulting sensory disturbances can significantly impact an individual's quality of life.

The Anatomical Landscape of Sensation

Sensation, in its myriad forms, relies on a complex network of anatomical structures. These structures include the abdominal wall, spinal cord, peripheral nerves, and specialized receptors. Each component plays a vital role in detecting, transmitting, and interpreting sensory information. Disruptions at any point along this pathway can manifest as paresthesia.

The Abdominal Wall: More Than Just a Barrier

The abdominal wall, often viewed as a protective shield, is a multilayered structure composed of skin, muscle, and nerves. These components work together to provide support, movement, and sensory input. The intricate network of nerves within the abdominal wall is responsible for detecting touch, pressure, temperature, and pain.

Damage or irritation to these nerves, such as from surgery or abdominal wall pain syndromes, can lead to localized paresthesia. These types of paresthesia can manifest as tingling, burning, or numbness in the affected area.

The Spinal Cord: The Sensory Highway

The spinal cord serves as the primary communication pathway between the brain and the rest of the body. Encased within the vertebral column, this vital structure relays sensory information from the periphery to the brain for processing. Disruptions to the spinal cord, whether from injury, compression, or disease, can have profound effects on sensation.

These disruptions may manifest as widespread paresthesia, affecting areas both above and below the level of the lesion. Conditions such as spinal cord compression or transverse myelitis can significantly impair sensory transmission, leading to chronic paresthesia.

Peripheral Nerves: Branches of the Sensory Tree

Extending from the spinal cord, the peripheral nerves act as the final branches of the sensory tree, reaching out to innervate every part of the body. These delicate structures transmit sensory signals from the skin, muscles, and organs to the central nervous system. Peripheral neuropathy, a common cause of paresthesia, arises from damage to these nerves.

This damage can result from a variety of factors, including diabetes, trauma, infection, and exposure to toxins. When peripheral nerves are compromised, individuals may experience paresthesia in the form of tingling, numbness, burning pain, or a combination of these sensations.

Nociceptors: Sentinels of Pain

Embedded within the skin, muscles, and other tissues, nociceptors are specialized sensory receptors that detect potentially harmful stimuli. These receptors are responsible for initiating the sensation of pain, alerting the body to danger.

When activated by physical or chemical stressors, nociceptors transmit electrical signals to the spinal cord and brain, triggering a cascade of events that ultimately lead to the perception of pain. Dysfunctional nociception can contribute to the development of paresthesia, particularly in conditions like fibromyalgia, where pain and altered sensation are prominent features.

Somatic Sensation: A Symphony of Sensory Input

Somatic sensation encompasses a wide range of sensory modalities, including touch, temperature, pain, and pressure. These sensations are essential for interacting with the environment and maintaining bodily integrity. Each sensory modality relies on specialized receptors and neural pathways to transmit information to the brain.

For example, touch receptors detect fine details and textures, while temperature receptors respond to changes in heat and cold. Pain receptors, as mentioned earlier, detect noxious stimuli, and pressure receptors sense mechanical forces applied to the skin. The brain integrates these diverse sensory inputs to create a coherent representation of the body and its surroundings. Disruptions in somatic sensation, such as those seen in paresthesia, can significantly impair an individual's ability to perceive and respond to the world around them.

Diagnosing Paresthesia: Uncovering the Root Cause

Paresthesia, that unwelcome guest of sensation, rarely appears uninvited. The journey to understanding the underlying cause of these unsettling sensations can be a complex, multi-staged process. Accurate diagnosis is paramount to ensuring effective treatment and preventing potential long-term complications. This section will explore the diagnostic pathway, highlighting the roles of various medical professionals, the significance of physical examinations and blood tests, and the utility of advanced diagnostic procedures.

The Primary Care Physician: Your First Port of Call

Typically, the primary care physician (PCP) serves as the initial point of contact for individuals experiencing paresthesia. The PCP will conduct a thorough review of your medical history, including any pre-existing conditions, medications, and relevant lifestyle factors. They will also inquire about the specific characteristics of your paresthesia, such as its location, duration, intensity, and any associated symptoms.

This initial assessment is crucial for formulating a differential diagnosis and guiding further investigations. The PCP may be able to identify obvious causes, such as medication side effects or vitamin deficiencies, and initiate appropriate treatment.

When to Seek Neurological Expertise

While a PCP can manage many cases of paresthesia, a referral to a neurologist is often necessary when the symptoms are persistent, severe, or accompanied by other neurological signs. Neurologists possess specialized expertise in diagnosing and treating disorders of the nervous system.

They can perform more in-depth neurological examinations and order advanced diagnostic tests to pinpoint the underlying cause of paresthesia. Indications for neurological referral include:

• Unexplained paresthesia that does not resolve with initial treatment.
• Paresthesia accompanied by weakness, numbness, or loss of coordination.
• Suspected neurological conditions, such as multiple sclerosis or stroke.
• Evidence of nerve damage or compression.

The Importance of Physical Examination

A comprehensive physical examination is an indispensable part of the diagnostic process. The physician will assess your:

• Sensory function (touch, temperature, pain).
• Motor strength and reflexes.
• Coordination and balance.
• Cranial nerve function.

Specific tests, such as the pinprick test and vibration test, can help identify areas of sensory loss or abnormality. Assessing motor function can reveal underlying nerve damage or muscle weakness. These findings, combined with your medical history, help to narrow down the list of potential diagnoses.

Blood Tests: Unmasking Underlying Conditions

Blood tests play a crucial role in identifying underlying medical conditions that may be contributing to paresthesia. Common blood tests include:

• Complete Blood Count (CBC): To assess for infection, inflammation, or anemia.
• Comprehensive Metabolic Panel (CMP): To evaluate kidney and liver function, electrolyte balance, and blood glucose levels.
• Vitamin B12 and D Levels: To rule out vitamin deficiencies.
• Thyroid Function Tests: To assess thyroid hormone levels, as thyroid disorders can cause paresthesia.
• Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP): To detect inflammation in the body.
• Lyme Disease Testing: If Lyme disease is suspected based on your history and symptoms.
• Glucose Testing (A1c): To evaluate for diabetes or pre-diabetes.

Advanced Diagnostic Tests: Delving Deeper

When the initial assessment and blood tests do not reveal the cause of paresthesia, advanced diagnostic tests may be necessary to further evaluate nerve function and identify structural abnormalities.

These tests are typically performed by specialists, such as neurologists or electrodiagnostic physicians.

Nerve Conduction Study (NCS)

A nerve conduction study (NCS) measures the speed at which electrical signals travel through your peripheral nerves. Electrodes are placed on the skin over specific nerves, and mild electrical impulses are delivered. The NCS can help identify nerve damage or dysfunction, such as:

• Peripheral neuropathy.
• Carpal tunnel syndrome.
• Ulnar nerve entrapment.

Electromyography (EMG)

Electromyography (EMG) assesses the electrical activity of your muscles. A small needle electrode is inserted into the muscle, and the electrical signals produced during muscle contraction are recorded. The EMG can help differentiate between nerve and muscle disorders, and it can also identify the specific muscles affected by nerve damage.

Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging (MRI) uses powerful magnets and radio waves to create detailed images of your brain, spinal cord, and peripheral nerves. MRI can help identify:

• Structural abnormalities, such as tumors or cysts.
• Inflammation or demyelination (damage to the protective covering of nerves) in the brain or spinal cord (as seen in multiple sclerosis).
• Nerve compression or entrapment.

Computed Tomography (CT) Scan

A computed tomography (CT) scan uses X-rays to create cross-sectional images of your body. CT scans are particularly useful for evaluating:

• Bone structures.
• Spinal cord compression.
• Tumors.

While MRI is generally preferred for imaging soft tissues, CT scans can provide valuable information in certain cases.

Skin Biopsy

A skin biopsy involves removing a small sample of skin for microscopic examination. This test can be useful for diagnosing small fiber neuropathy, a condition that affects the small sensory nerves in the skin. A skin biopsy can help quantify the density of these nerve fibers and identify any abnormalities.

Treatment Options for Paresthesia: Managing Symptoms and Addressing Underlying Causes

Diagnosing Paresthesia: Uncovering the Root Cause Paresthesia, that unwelcome guest of sensation, rarely appears uninvited. The journey to understanding the underlying cause of these unsettling sensations can be a complex, multi-staged process. Accurate diagnosis is paramount to ensuring effective treatment and preventing potential long-term complications. But what happens after the diagnosis? Treatment strategies for paresthesia are diverse, aiming to alleviate symptoms while diligently addressing the underlying root cause.

This section delves into the multifaceted approaches employed to manage and mitigate paresthesia, highlighting the crucial need to target the causative factors for sustained relief.

A Multifaceted Approach to Paresthesia Treatment

Managing paresthesia requires a comprehensive strategy that combines symptomatic relief with targeted treatment of the underlying condition. It is crucial to emphasize that masking symptoms without addressing the core issue offers only temporary respite and may allow the underlying pathology to progress.

A truly effective treatment plan involves identifying the root cause – be it diabetes, vitamin deficiency, or nerve compression – and initiating interventions to correct the imbalance.

Symptomatic Relief: Addressing the Immediate Discomfort

While addressing the underlying cause is paramount, alleviating the immediate discomfort caused by paresthesia is equally important for improving quality of life. Several options exist for managing the bothersome sensations:

Pain Relief Medications: A Double-Edged Sword

Over-the-counter (OTC) pain relievers, such as ibuprofen or acetaminophen, can provide mild relief for some individuals. However, their efficacy is limited for the nerve-related pain often associated with paresthesia.

Prescription pain relievers, including opioids, should be used with extreme caution and only under strict medical supervision due to the risk of dependence and other adverse effects. Opioids merely mask the pain without addressing the underlying nerve dysfunction.

Neuropathic Pain Medications: Targeting Nerve Activity

Antidepressants, particularly tricyclic antidepressants (TCAs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs), have demonstrated efficacy in managing neuropathic pain. These medications modulate neurotransmitters in the brain, altering pain perception.

It is essential to note that antidepressants may take several weeks to exert their full effect, and side effects should be carefully monitored.

Anticonvulsants, originally developed to treat seizures, can also be effective in managing nerve pain. Gabapentin and pregabalin are commonly prescribed anticonvulsants for paresthesia.

These medications work by stabilizing nerve activity and reducing the abnormal firing that contributes to pain sensations.

Topical Treatments: Localized Relief

Topical creams containing capsaicin, the active ingredient in chili peppers, can provide localized pain relief. Capsaicin works by depleting substance P, a neurotransmitter involved in pain signaling.

Lidocaine patches offer another topical option, numbing the affected area and reducing nerve sensitivity. These patches can be particularly helpful for localized paresthesia.

Vitamin Supplementation: Addressing Nutritional Deficiencies

Nutritional deficiencies, particularly vitamin B12, vitamin D, and magnesium, can contribute to paresthesia. Identifying and correcting these deficiencies through supplementation can significantly improve nerve function.

It is essential to consult with a healthcare professional to determine the appropriate dosage and form of supplementation based on individual needs and blood levels.

Nerve Blocks: Targeted Pain Management

Nerve blocks involve injecting local anesthetics near specific nerves to block pain signals. These injections can provide temporary relief and may be used diagnostically to identify the source of pain.

While nerve blocks can be effective for short-term pain management, they do not address the underlying cause of paresthesia and are not a long-term solution. Repeated injections may carry risks and should be carefully considered.

The Importance of Addressing the Underlying Cause

The ultimate goal of paresthesia treatment is to identify and address the underlying cause. This may involve:

• Managing diabetes: Strict blood sugar control can prevent or slow the progression of diabetic neuropathy.
• Treating autoimmune diseases: Immunosuppressant medications can help reduce inflammation and nerve damage in autoimmune conditions like multiple sclerosis.
• Correcting vitamin deficiencies: Supplementation can restore nerve function and alleviate symptoms.
• Relieving nerve compression: Physical therapy, chiropractic care, or surgery may be necessary to alleviate pressure on nerves.
• Avoiding toxins: Identifying and eliminating exposure to toxins can prevent further nerve damage.

In conclusion, treating paresthesia is a nuanced process. A comprehensive approach that integrates symptomatic relief with targeted treatment of the underlying cause is crucial for achieving lasting improvement in sensation and overall well-being.

Understanding Pain and Sensation: Key Concepts for Paresthesia Management

Paresthesia, that unwelcome guest of sensation, rarely appears uninvited. The journey to understanding the underlying cause of these unsettling sensations can be a complex, multi-staged process. Accurate diagnosis and effective management of paresthesia rely heavily on a solid grasp of fundamental concepts related to pain and sensation. This section delves into these critical elements, including pain perception, somatic sensation, differential diagnosis, pain scales, and medical questionnaires.

The Subjective Reality of Pain Perception

Pain, unlike a purely objective measurement, is an intensely personal and subjective experience. What one individual describes as a mild discomfort, another might perceive as excruciating pain. This variability is influenced by a multitude of factors, including:

• Psychological State: Anxiety, stress, and depression can significantly amplify pain perception.

• Past Experiences: Previous encounters with pain shape our expectations and responses to future painful stimuli.

• Cultural Background: Societal norms and beliefs can influence how individuals express and cope with pain.

Understanding this inherent subjectivity is paramount in managing paresthesia. It requires clinicians to adopt a patient-centered approach, prioritizing the individual's unique experience and perspective. A dismissive or invalidating approach can undermine trust and hinder the effectiveness of treatment.

Somatic Sensation: The Body's Sensory Landscape

Somatic sensation encompasses a range of sensory modalities, including touch, temperature, pressure, vibration, and pain. These sensations arise from specialized receptors located throughout the body, particularly in the skin, muscles, and joints. The signals from these receptors travel along peripheral nerves to the spinal cord and ultimately to the brain, where they are processed and interpreted.

Paresthesia represents a disruption of this intricate sensory pathway. Damage to peripheral nerves, spinal cord lesions, or even central nervous system dysfunction can lead to aberrant sensory experiences. These can manifest as tingling, numbness, burning, or prickling sensations, often occurring in the absence of any external stimulus.

Therefore, a thorough understanding of normal somatic sensation is essential for recognizing and characterizing paresthesia. It allows clinicians to pinpoint the location and nature of the sensory disturbance, providing valuable clues to the underlying cause.

Differential Diagnosis: Navigating the Diagnostic Maze

Paresthesia can be a symptom of a vast array of medical conditions, ranging from relatively benign nerve compression to serious neurological disorders. This diagnostic ambiguity necessitates a systematic and rigorous approach known as differential diagnosis.

Differential diagnosis involves considering all possible causes of the patient's symptoms and then systematically ruling out or confirming each one through a combination of:

• Detailed Medical History: A comprehensive assessment of the patient's symptoms, past medical conditions, medications, and lifestyle factors.

• Physical Examination: A thorough neurological examination to assess sensation, motor function, reflexes, and cranial nerve function.

• Diagnostic Testing: Blood tests, nerve conduction studies, electromyography, and imaging studies may be necessary to identify the underlying cause.

The key to successful differential diagnosis is to maintain a broad perspective, avoid premature closure, and prioritize evidence-based reasoning.

Pain Scales: Quantifying the Intangible

Given the subjective nature of pain, it can be challenging to accurately quantify and track its intensity. Pain scales provide a standardized method for patients to rate their pain, enabling clinicians to monitor treatment response and make informed decisions.

Several types of pain scales are commonly used, including:

• Numerical Rating Scales (NRS): Patients rate their pain on a scale of 0 to 10, with 0 representing no pain and 10 representing the worst pain imaginable.

• Visual Analog Scales (VAS): Patients mark their pain level on a continuous line, with one end representing no pain and the other end representing the worst pain imaginable.

• Categorical Scales: Patients choose a descriptor from a list, such as "mild," "moderate," or "severe."

It's crucial to remember that pain scales are subjective tools and should be used in conjunction with other clinical information.

Medical Questionnaires: Unveiling Hidden Clues

Medical questionnaires can be invaluable tools for gathering comprehensive information about a patient's symptoms, medical history, and functional limitations. Standardized questionnaires can help identify patterns and risk factors that might be missed during a typical clinical interview.

Examples of relevant questionnaires include those assessing:

• Neuropathic Pain: Tools like the Douleur Neuropathique 4 Questions (DN4) can help identify neuropathic pain characteristics.

• Functional Disability: Questionnaires can assess the impact of pain on daily activities and quality of life.

• Psychological Distress: Questionnaires can screen for anxiety, depression, and other psychological factors that can influence pain perception.

By systematically collecting this information, medical questionnaires can contribute to a more accurate and comprehensive assessment of the patient's condition, guiding diagnosis and treatment planning.

So, there you have it – a rundown of what might be causing that pins and needles abdomen sensation and when it's time to get it checked out. Hopefully, this helps you understand what's going on and guides you toward the right path. Don't hesitate to reach out to a healthcare professional if you're concerned about your pins and needles abdomen; they're the best resource for personalized advice and care!