Publisher Summary Pins and needles are perhaps more accurately designated tingling paraesthesiae and constitute a common and universally recognized symptom complex, requiring no further elaboration from the patient. The major causes of pins and needles include the effects of trauma, ischemia, or metabolic changes on cutaneous nerve fibers or nerve endings. The exact distribution of the pins and needles should be established. If the symptoms are both intermittent and localized, the exact circumstances in which they occur must be established. Severe cold, Raynaud's phenomenon, and peripheral arterial and venous diseases may all cause intense pins and needles because of ischemia of the cutaneous nerve filaments and nerve endings. Cold exposure typically causes intense pins and needles as the circulation recovers. Peripheral neuropathy is often suspected in patients complaining of widespread pins and needles. A careful history of the location, duration, and circumstances under which pins and needles occur usually reveals the diagnosis.