Tactile hallucinations and Formication: Strange skin sensations including insects crawling on your skin
Ross Hauser, MD
In this article we are going to discuss one possible explanation as to why you have symptoms of formication, that is the sensation of creepy crawlies or bugs crawling on your skin. The medical term formication comes from the Latin for ants and can be translated as a condition of “ants crawling on the skin.” We are also going to discuss tactile hallucinations, a strange sensation where the skin feels things that are not there, such as a touch, or heat, or any sensation that one would “feel.”
While formication and tactile hallucinations can be seen as symptoms of dementia or advancing mental illness, vitamin deficiency, or a hormonal problem in post-menopausal women, in this article I hope to present the case that in some people, these symptoms are part of a myriad of “neurological-type” disorders caused by cervical spine and neck instability. That is, in some people, these conditions can be caused by pressure or compression of the posterior spinal cord caused by increasing spinal tension created by a poor cervical curve or neck instability.
I don’t think I have dementia, I think I had a bad cervical fusion.
The problem with these conditions of skin hallucination is that when someone tells their doctor about it, in many cases, that doctor will look into drug use, illegal or prescribed, or start a mental illness assessment. Very few doctors will make a connection between a cervical spine injury or surgery causing these problems. The people who have been down this road of searching for answers are the people who will typically reach out to us because none of the answers they are getting are answers. Some of the treatments they have had, including surgery, worsened their problems.
Before we move on. Many people have very successful neck surgeries. Getting a sensation of ants crawling on your skin after neck surgery is rare, but it does happen. Here is an example story from emails we receive:
Cervical fusion after whiplash and bugs crawling on my skin. One doctor thinks I have the onset of dementia.
I have had a cervical fusion. I “needed” this surgery because of a severe whiplash injury. I am still suffering from intense sharp neck pain. But it is a different sharp neck pain than the pain I had before cervical fusion. I guess the doctors fixed one pain and gave me another. I am now having issues with my bladder. I am also having memory and brain fog problems and my doctors actually think I am in the early stages of dementia. I told them that I do not think my problem is early-stage dementia, I think I have a neck problem. I asked them if my arguing the point coherently, wouldn’t that be proof enough my “neurological” problems are not “all in my head.” They still think it is a decline in my cognitive function caused by dementia. This is especially true when I complain that I have a sensation of things crawling on my skin. They throw mental illness in there as well and say I am depressed.
I am itching my head like crazy. I should probably not use the word crazy.
I suffer from many conditions, my doctors are focusing on chronic ear and sinus infections. I have “everything.” Hearing sensitivity, vision problems, choking sensation, dizziness, just some among many problems. I am also having problems which my doctors are suggesting may be some type of early-onset Alzheimer’s disease or dementia. I am way too young for this type of diagnosis yet my doctors are ordering a lot of brain scans. I do have confusion, brain fog, trouble focusing but I do not think it is dementia. I am having these weird symptoms that my doctors keep wanting to explore for my “brain,” problem. I have a sensation of “dissociative amnesia,” like I do not belong in the current reality and I forget who I am. I also have these sensations like something is crawling on my skin or there is something crawling in my scalp. I am itching my head like crazy. I should probably not use the word crazy.
Why would these people’s doctors focus on the problem of dementia when they suffered from so many “non-dementia” type conditions?
Why would these people’s doctors focus on the problem of dementia when they suffered from so many “non-dementia” type conditions? Typically a symptom of burning tongue is not considered a dementia-like symptom, nor is ear fullness, sinus congestion, or various gastrointestinal distress problems. But the doctors are exploring dementia or neurological breakdown just the same. The reason is that to get any treatments some doctors will require a psychiatric and neurological assessment to rule out these disorders, it is the standard of care to test for dementia when these symptoms appear, especially in patients in middle age or older.
If you suffer from many similar conditions, you probably know from first-hand experience that without a central identifiable cause to your problems, the doctors treat the symptoms, in this case, brain fog, concentration problems, and the main point of this article the crawling, creepy sensations brought on by tactile hallucinations with an understanding that these problems can be helped with the same general recommendations given to dementia patients.
Look at this recent study from doctors examining psychotic symptoms in older people without dementia. The key here is “without dementia.” This paper was published in the journal Public Library of Science One. (1) If your doctors keep up on the research they may have come across this study and similar studies that suggest that creepy crawling sensation should be viewed as the onset of a long journey towards dementia. For the many people, we see here at our neck center, we see it as the culmination of a long journey of cervical spine and neck instability.
Let’s look at the summary learning points of this paper:
- This is a seven-year follow-up study aiming to determine the incidence of psychotic symptoms and their development into clinical cognitive impairment. People over the age of 60 were recruited into this study and followed for seven years to see how far their cognitive skills declined.
The sensation of tactile hallucination is number 1
- Eight percent of the people in this study had at least one psychotic symptom within the 7 year period of the study. The symptoms were:
- 4.5% had Visual/tactile hallucinations
- 3.0% had Persecutory delusions
- 2.5% had Auditory hallucinations
- A total of 57.8% of individuals with psychotic symptoms developed cognitive impairment after 7 years. Visual/tactile hallucinations were the only psychotic symptom predictive of this impairment
Simply, when a patient starts “seeing things,” or feels that something is crawling on their skin, you should look for developing cognitive impairment.
Let’s be clear. People can have early-onset dementia and it can be caused by many different problems. In this article we present one possible alternative answer, that is cervical spine and neck instability cause nerve compression and dysfunction which causes the shooting off of a lot of bad messages between the brain and the nervous system.
“It is possible that many patients start out with symptoms of formication and slowly progress to developing circumscribed delusions as a way of explaining the cause of the stinging, biting, and crawling sensations.”
This quotation comes from “Clinical Cases in Psychocutaneous Disease.” The chapter: Formication Without Delusions. (2)
Here we have medical professionals suggesting that people who suffer from formication, with nowhere else to turn, develop delusional tendencies and then can be treated with appropriate medications. But what if these strange symptoms were coming from a nerve short circuit in the neck and the patient was suffering these symptoms “without delusion.”
So where are these hallucinations coming from? Disrupted brain function from a stiff neck?
If it is strictly a dementia problem, then they would come from the problems created by dementia. But what if they were coming from something else? Let’s take a moment to assess a recent study published in the journal Frontiers in Human Neuroscience. (3) We are going to look at the summary learning points and provide some explanatory notes:
Phantom skin sensation
The learning points from the study are in quotations. The paragraphs are explanatory notes we added.
“One of the most common situation(s) in which touch does not correspond to physical stimulation is the false tactile perception i.e., tactile hallucination, in which people may experience touch sensation in absence of any kind of external stimulus. Hallucinations have been reported in different neurological and psychiatric disorders: psychotic states, Parkinson’s disease, dementia, phantom limb (the sensation in foot pain in a limb that had been amputated), and drug abuse. However, the most convincing evidence about the predictive nature of touch comes from the illusory experience of tactile perception generated by an external stimulus delivered in a different sensory modality. (In other words, you see something and this causes you to “feel something.” You can look at a picture of winter and suddenly feel cold. You can look at a picture of a beach and suddenly feel hot.)
“A number of studies have demonstrated that around 30% of normal subjects report tactile sensations on their own hand when a fake (rubber) hand is located very close/superimposed to one’s own hidden hand.” (If the rubber hand is stroked with a feather, the person would feel a “tickle sensation.”)
In this study, the researchers suggest that even a “normal,” brain can misinterpret the signals that the eyes (visual sensation) are sending it. You would feel cold looking at a winter picture because your brain is predicting that something cold (even looking cold) SHOULD make you feel cold.
Why is a stiff neck that the very last clue that your problems of crawling skin may come from cervical spinal instability?
When someone talks to our staff about their conditions and symptoms, they, like the examples I demonstrated above, will tell us that initially, when they started having these weird symptoms, there was a “chase to eliminate” what it could possibly be. As you probably know from your own medical history, you are going down the path of “what it isn’t.”
Is it Magnesium deficiency?
For some, there were muscle spasms or the sensation that their muscles were undulating or making waves under their skin. Since this can be caused by a magnesium deficiency, magnesium supplementation was recommended. As the symptoms continued, magnesium deficiency was ruled out.
Symptoms of crawling skin have been linked to post-menopause. It is thought that hormone replacement therapy may be the answer. Of course, this would not benefit men or women who were not post-menopausal.
Neuropathy? Psychiatric examinations?
As these people got deeper and deeper into their testing and diagnosis, they were tested for more serious conditions related to symptoms of tactile hallucinations and creepy, crawling skin. This would include a diagnosis of multiple sclerosis and Parkinson’s disease. When these tests came back negative there was little else to explore. So as we discussed above the patient, in some cases accepted the fact that they must be delusional and psychiatric examinations were recommended.
My neck hurt. I had an adjustment. Then everything changed.
To be very, very clear, tactile hallucinations and formication are symptoms of neurological disorders and they are symptoms of possible psychiatric disorders. They are also symptoms and conditions of cervical spine and neck instability.
This is a story we hear very often and the main reason that someone winds up at our neck center. Everything has been tested for, little help or symptom alleviation was achieved, more medications, more tests, and no answers. Then one day someone facing all these problems mentioned to a health care provider, almost as an afterthought, that they had a very stiff and painful neck and if there was “something that could be done for that?”
In many cases, that person was sent off to physical therapy or most likely a chiropractor. Suddenly, everything changed for that person. Their story goes something like this:
I kept developing new symptoms, it seemed that every day something else popped up that I had not noticed before. More muscle cramping, tingling in my feet and arms, anxiety attacks, and racing heartbeat for some. I was even scheduled to have a cardiac evaluation. As with my other symptoms, my skin hallucinations were getting worse as well. One day I was in my living room and it felt like I was in the shower. One day my clothes felt like they were moving by themselves on my body.
I have always had nagging neck pain. Because of all these other symptoms, this problem was put on the back burner, and really never gave much thought other than taking a pill or rubbing my neck. As I look back I do remember sometimes when I would rub my neck and I would lose track of where I was or what I was doing. I thought that was just me responding to the small amount of relief the massage was giving me. Because my neck pain was flaring up and now I was developing more frequent headaches I went to a chiropractor.
I had my adjustment, my neck felt better, and then I went home. As the day and next day passed I noticed that my symptoms and conditions were greatly reduced. I started having a panic attack because I did not know what this meant. I went online and started seeing that neck instability may be a cause of my problems and somehow this one adjustment was not only working on my neck pain but on my symptoms. Slowly the symptoms came back but I felt as if I had made a discovery, there was a connection between my neck pain and the feeling of ants crawling on my skin.
I went back for more adjustments and I found the symptoms I suffered from lessened but they also came back. I started searching for a more long-term solution and started to explore everything with cervical fusion surgery as the last resort if I could not find any other treatment.
In this case, a cervical fusion made the hallucinations go away
In 2019 a case study published in the BMJ (British Medical Journal) case reports (4) comes to us from doctors at the Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge. The title of this case history is “I am not delusional!” Sensory dysaesthesia secondary to degenerative cervical myelopathy.
In this case history, the doctors reported on “an unusual case of a patient presenting with prominent and atypical sensory symptoms. The patient repeatedly presented to accident and emergency complaining of her body resembling a wet gel-like substance that she attributed to the use of olive oil moisturizing cream. The patient was found to have myelopathic signs on examination and MRI consistent with severe cervical myelopathy. She subsequently underwent a successful decompressive anterior cervical discectomy, as recommended by international guidelines. This case serves to remind health professionals of uncommon presentations of common disease and the importance of maintaining a wide initial differential diagnosis.” In other words, do not dismiss psychological symptoms as being a psychological problem. It could be in the neck.
Many of you are aware of the umbrella term dysaesthesia. A recent paper in the Journal of the American Academy of Dermatology (5) describes this term in this way: “Dysesthesia is a generic term for a cutaneous symptom–such as pruritus, burning, tingling, stinging, anesthesia, hypoesthesia, tickling, crawling, cold sensation, or even pain–without a primary cutaneous condition in a well-defined location that is often caused by nerve trauma, impingement, or irritation.”
What are we seeing in this image? A possible answer? The messages to and from the brain are being delayed. Misinformation now fills the void as messages move more slowly
In other articles on this website, I explore problems that many of the people we see have. Symptoms include tactile allodynia or painful to the touch skin, skin sensations where one half of their body will feel hot and one half of their body will feel cold, rashes, and problems of sweating. The sensation is felt as the nerve impulses go up the posterior columns of the spinal cord to the parts of the brain that sense stuff that is the somatosensory centers of the brain. But what happens if this messenger-information highway has a roadblock or traffic is being diverted from and many of the highway lanes are closed? The messages move more slowly, priority messages may be delayed.
In this image, we see that this patient has cervical spine instability. This is allowing the rear or posterior spinal canal to hit against the walls of the spinal canal. The pressure being created by hypermobile, unstable cervical vertebrae was causing this patient’s whole body to be in a state of distress. They had the sensation that their body was buzzing or vibrating, their skin had different temperatures from one side to the other, and itching sensations consistent with the sensation that something was crawling on them. Our treatments to alleviate this patient’s problems focused on removing the pressure on the spinal cord by stabilizing the cervical vertebrae and restoring the natural curve of the cervical and thoracic spine with Prolotherapy injections. This is explained below.
Strange sensations in the skin
In the video below, Ross Hauser, MD, and Brian Hutcheson DC discuss the problems of chronic skin sensations that are common symptoms and findings in cases of cervical instability. These include symptoms like abnormal temperature regulation over half of their body or certain areas that are hot or cold compared to the rest of the body. Problems of specific areas that are hypersensitive or numb compared to the rest of the body, and other odd skin sensations, including localized swelling, vibration, and severe itching, and sense of crawling skin that has not been resolved by other traditional treatments including dermatology, rheumatology, and neurology.
Before we move on. Many of the problems we are describing here do respond very well to conservative and traditional treatments. Many times they will succeed at a high rate and to the patient’s satisfaction. These are not the people we see at our center. We see the people who are being symptom managed without great results. Again, we will focus on the problem of cervical spine instability as the underlying cause for many of these problems and the symptoms of strange sensations in the skin.
Explanatory and learning points from this video are highlighted and detailed below.
For some, the missing diagnosis for skin sensation issues is the cervical spine
- The clues of upper cervical instability can be found in the symptoms of the skin. Hot skin, cold skin, itching, formication, sensitivity to touch, skin rashes on the skin. This may be the missing diagnosis and why people do not get the care they need.
What are we seeing in this image?
A Digital Motion X-Ray or DMX is a tool we use to help understand a patient’s neck instability and how we may be able to help the patients with our treatments. In the illustration below a patient who suffered from upper cervical instability demonstrated hypermobility of the C1-C2. This hypermobility can result in common symptoms of neck pain, headaches, dizziness, vertigo, tinnitus, concentration difficulties, anxiety, skin flushes, hot skin, cold, skin, crawling skin, and sensitivity to pain.
The treatment of cervical spine instability at the Hauser Neck Center – Research on cervical instability and Prolotherapy
In the above article, we suggest that many of the problems related to among other symptoms, crawling skin sensations can be treated by addressing cervical spine instability in the neck. There are many ways to treat this problem. Our preferred choice is regenerative medicine injections that begin with Prolotherapy.
Caring Medical has published dozens of papers on Prolotherapy injections as a treatment in difficult to treat musculoskeletal disorders. Prolotherapy is an injection technique utilizing simple sugar or dextrose. Our research documents our experience with our patients.
In 2015, our research team at Caring Medical published findings in the European Journal of Preventive Medicine investigating the role of Prolotherapy in the reduction of pain and symptoms associated with increased cervical intervertebral motion, structural deformity, and irritation of nerve roots and as mentioned above, irritation of the spinal cord.
Twenty-one study participants were selected from patients seen for the primary complaint of neck pain. Following a series of Prolotherapy injections, patient-reported assessments were measured using questionnaire data, including range of motion (ROM), crunching, stiffness, pain level, numbness, and exercise ability, between 1 and 39 months post-treatment (average = 24 months).
- Ninety-five percent of patients reported that Prolotherapy met their expectations in regards to pain relief and functionality. Significant reductions in pain at rest, during normal activity, and during exercise were reported.
- Eighty-six percent of patients reported overall sustained improvement, while 33 percent reported complete functional recovery.
- Thirty-one percent of patients reported complete relief of all recorded symptoms. No adverse events were reported.
We concluded that statistically significant reductions in pain and functionality, indicating the safety and viability of Prolotherapy for cervical spine instability. (5)
In 2014, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments in The Open Orthopaedics Journal. (6) We are honored that this research has been used in at least 6 other medical research papers by different authors exploring our treatments and findings and cited, according to Google Scholar, in more than 40 articles.
This is what we wrote in this paper: “To date, there is no consensus on the diagnosis of cervical spine instability or on traditional treatments that relieve chronic neck instability issues like those mentioned above. In such cases, patients often seek out alternative treatments for pain and symptom relief. Prolotherapy is one such treatment that is intended for acute and chronic musculoskeletal injuries, including those causing chronic neck pain related to underlying joint instability and ligament laxity. While these symptom classifications should be obvious signs of a patient in distress, the cause of the problems are not so obvious. Further and unfortunately, there is often no correlation between the hypermobility or subluxation of the vertebrae, clinical signs or symptoms, or neurological signs (such as excessive sweating or inability to sweat and temperature dysregulation or other skin sensations mentioned in this article) or symptoms.”
What we demonstrated in this study is that the cervical neck ligaments are the main stabilizing structures of the cervical facet joints in the cervical spine and have been implicated as a major source of chronic neck pain and in the case of many of the symptoms we mentioned above.
Summary and contact us. Can we help you? How do I know if I’m a good candidate?
We hope you found this article informative and it helped answer many of the questions you may have surrounding strange skin sensations. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.
References for this article:
1 Soares WB, Dos Santos EB, Bottino CM, Elkis H. Psychotic symptoms in older people without dementia from a Brazilian community-based sample: A seven years’ follow-up. PloS one. 2017 Jun 16;12(6):e0178471. [Google Scholar]
2 Nguyen T.V., Wong J.W., Koo J. (2014) Formication Without Delusions. In: Clinical Cases in Psychocutaneous Disease. Clinical Cases in Dermatology. Springer, London.
3 Mowforth OD, Davies BM, Kotter MR. “I am not delusional!” Sensory dysaesthesia secondary to degenerative cervical myelopathy. BMJ Case Reports CP. 2019 Apr 1;12(4):e229033. [Google Scholar]
4 Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease: Neurocutaneous dysesthesias. Journal of the American Academy of Dermatology. 2016 Feb 1;74(2):215-28. [Google Scholar]
5 Hauser RA, Steilen D, Sprague IS. Cervical Instability as a Cause of Barré-Liéou Syndrome and Definitive Treatment with Prolotherapy: A Case Series. European Journal of Preventive Medicine. 2015;3(5):155-66. [Google Scholar]
6 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]
This article was updated November 10, 2021