Burning and Tingling in Lyme Disease: What's Causing It

When Your Nerves Set Off Alarms

One of the most common — and most confusing — symptoms I see in Lyme disease patients is a burning or tingling sensation in the hands and feet. For many, it feels like the nerves are on fire, especially at night. Others describe it as pins and needles, crawling sensations, or electric shocks.

They often come to me wondering: Is this neuropathy? Could it be MS? Why is it worse at night?

The Answer: Small Fiber Neuropathy

In many of these cases, the problem is small fiber neuropathy — a type of nerve damage that affects the small sensory fibers responsible for pain, temperature, and touch. These fibers are also part of the autonomic nervous system, which controls digestion, heart rate, and more.

In Lyme disease, small fiber neuropathy is not rare — it’s underrecognized. For a deeper look at the research, see Autonomic Dysfunction, Small Fiber Neuropathy and Lyme Disease.

How Lyme Disease Triggers Burning and Tingling

Lyme disease doesn’t just affect the joints and brain. It can trigger inflammation in the peripheral nerves. When Lyme bacteria irritate or damage small nerve fibers, patients develop:

Burning in the soles of the feet or palms
Tingling, numbness, or crawling sensations
Discomfort with even light touch (allodynia)
Electric shock sensations or buzzing
Temperature sensitivity — feeling heat or cold more intensely

These symptoms often worsen at night, disrupting sleep and increasing fatigue.

It Can Look Like Diabetic Neuropathy or MS

Many of my patients were told their symptoms looked like diabetic neuropathy, even though they didn’t have diabetes. Others were referred to neurologists who raised the possibility of multiple sclerosis (MS).

While both are valid concerns, Lyme disease needs to be on the differential — especially if there are other signs like migratory pain, fatigue, cognitive fog, or a history of tick exposure.

For more on why Lyme disease is frequently confused with other conditions, see Lyme Disease Neuropathy: Symptoms and What Causes It.

Why Standard Tests Miss It

Standard EMG and nerve conduction studies assess large nerve fibers. Small fiber neuropathy affects the smallest sensory and autonomic fibers, which these tests cannot measure. A skin biopsy measuring intraepidermal nerve fiber density (IENFD) is the most widely accepted diagnostic tool.

When burning and tingling persist but standard nerve tests are normal, small fiber neuropathy should be considered — especially in patients with Lyme disease. For more on testing limitations, see Small Fiber Neuropathy in Lyme Disease and COVID-19.

The Danger of Missing the Lyme Connection

What’s most frustrating for patients is when their symptoms are dismissed — or misdiagnosed entirely. If Lyme disease is the underlying cause, treating the infection can often reverse the neuropathy or prevent it from progressing.

But if it’s missed, the nerve pain can become chronic and debilitating.

You’re Not Imagining It — And You’re Not Alone

If you’re experiencing burning or tingling in your hands or feet — especially at night — and you’ve been told “it’s nothing” or “just stress,” it may be time to look deeper.

This kind of nerve pain has a name. And in the context of Lyme disease, it has a cause — and a treatment.

Frequently Asked Questions

Can Lyme disease cause burning and tingling in the hands and feet?
Yes. Lyme disease can trigger small fiber neuropathy, causing burning, tingling, numbness, and pain — particularly in the hands and feet.

Why is the burning worse at night?
Small fiber neuropathy symptoms often intensify at night because the body’s autonomic regulation shifts during sleep. Reduced sensory input also makes nerve pain more noticeable.

Could my symptoms be MS instead of Lyme?
The symptoms can overlap. Both Lyme disease and MS can cause tingling, numbness, and nerve pain. A thorough evaluation including Lyme testing should be part of any workup for suspected MS, especially in tick-endemic areas.

Why are my nerve tests normal if I have burning pain?
Standard EMG and nerve conduction studies only assess large nerve fibers. Small fiber neuropathy requires a skin biopsy for diagnosis and will not appear on routine testing.

Can burning and tingling from Lyme disease be reversed?
In many cases, yes. When Lyme disease is identified and treated, small fiber neuropathy symptoms can improve significantly or resolve completely.

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Burning or Tingling in the Hands and Feet? It Could Be Lyme disease.