My hands fall asleep very easily. And my toes are always cold. How do you distinguish between a nerve problem or circulation problem? I have normal blood pressure.

I have the cold toes and hands that fall asleep all the time as part of my symptoms as well. The last neuromuscular specialist I saw suggested that poor circulation due to my varicose veins could be causing (or at least contributing to) my problems.

I don't have an answer to your question at this time. But I do have an appointment with a vascular surgeon at the end of May to have this issue evaluated. I'll let you know what they do as far as testing, and any other info I find out.

I've done quite a bit of research online, and have found very few references to vascular issues causing the type of burning pain that I have - so I'm not very optimistic that this will lead anywhere. But at this point, the note is in my file that the NM specialist recommended a vascular evaluation - so the doctors won't want to pursue any other causes until I get the evaluation.

Sure would be nice if the doctor's would pursue more than one possibility at a time. I'd hate to find out what the cause of my problem is, only to find out that it's too late to do anything about it because the damage is done

I was thinking this too. I have varicose veins in my legs and arms (not face or back though...) and I keep seeing a commercial on tv that asks "if you have muscle spasms, burning etc. then we can help you treat your varicose veins and be rid of this"...
I keep asking my doc for a referral but he says no way this is due to vascular stuff... I guess it makes sense in my case cus I don't have varicose veins in my ears and scalp

sorry, the point of my post was to say that apparently a varicose vein treatment center that advertises on tv reports these symptoms as being vascular.

Be careful of the "varicose vein treatment centers" that advertise on TV. If you may have something more serious than cosmetic issues related to varicose veins, be sure you are being treated by an actual vascular surgeon.

About 5 years ago, I had laser ablation of the greater saphenous vein in one leg, along with phlebectomy on numerous surface veins. That leg is now unfortunately getting bad again, and the other leg was already pretty bad 5 years ago but never treated. I have burning/pain in both feet, but worse on the leg that was never treated.

I did read a case study recently about a person who had a serious motor mononeuropathy that was causing intermittent weakness/foot drop due to a large varicose vein that was impinging on a nerve located behind the knee, so I guess it can happen.

Workup is the only way. Venous ultrasound and ABI (arterial brachial index) are noninvasive. Nerve conduction study would show a problem with large fiber nerves. That said there is a lot of neurovascular overlap that can get tricky to figure out or may not even be possible to if tests don't show anything glaring...

My initial research into peripheral neuropathy came across vasculitis as a cause. My doctor told me I didn't have vasculitis so at this point I'm taking his word for it.

Vasculitis and arteritis are inflammation of the vessel walls due to a variety of reasons. This is totally different and nothing to do with venous or arterial flow or neurovascular issues.

Today I was laying down with my hands holding my head up from behind. Maybe 10 mins. Stood up and my hands had pins and needles. Took a good 20 seconds to go away.

Tunaboy that doesn't sound like anything out of the ordinary. Sounds like classic "falling asleep" sensation. Ahh the good ole days when the only tingling I ever had was from my hands or feet falling asleep.