An abnormal prickling feeling in the skin. A pins and needles sensation may occur when a person’s hand or foot “falls asleep.” However, persistent pins and needles or tingling is a sign of damage or irritation to nerves or of poor circulation in the affected area. Possible causes of pins and needles include nerve injury, lack of blood supply, diabetes mellitus, thyroid problems, vitamin Bl2 (cyanocobalamin) deficiency, carpal tunnel syndrome, transient ischemic attack, stroke, and multiple sclerosis.