Paresthesias

Sometimes patients complain of painful paresthesias. We often think of paresthesias as pins and needles or numbness and tingling. But,I wonder, how bad could numbness and tingling be? How could it be so severe that patients go into the emergency department or pain clinic requesting opioids?

Some friends of ours gave us peppers that they grew in their garden. They didn't know what kind of peppers they were, but they warned us, "they're pretty spicy." Being me, I took huge raw bite of one. It was hot. It turns out the peppers were Rocoto peppers, shown above. On the Scoville scale, a measurement of the spicy heat of peppers, it is high up there, along with habaneros and the scotch bonnet. It's spicy enough that I don't know what to do with our bag of peppers; I've tried adding it to various dishes but the kick is pretty impressive. In any case, that day I ate the raw pepper, my mouth and fingers were burning for hours, and it was painful. Sometimes it's important to know what a patient experiences, and after this run-in with the Rocoto, I can believe that neuropathic pain and paresthesias can be near unbearable.

Of course, this hasn't dissuaded me from taking more raw bites of the pepper. I'm not sure why I do it, but perhaps it's the same reason I keep signing up for more years of training.

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