Alcoholic neuropathy is damage to the nerves that results from excessive drinking of alcohol.
Causes, incidence, and risk factors:
The cause of alcoholic neuropathy is debated. It probably includes both a direct poisoning of the nerve by the alcohol, and the effect of poor nutrition associated with alcoholism. Up to half of all long-term heavy alcohol users develop this condition.
In severe cases, the nerves that regulate internal body functions (autonomic nerves) may be involved.
Risks for alcoholic neuropathy include:
- Long-term, heavy alcohol use
Alcoholism that is present for 10 years or more
Once the immediate alcohol problem has been addressed, treatment goals include:
- Controlling symptoms
- Maximizing ability to function independently
- Preventing injury
It is important to supplement the diet with vitamins, including thiamine and folic acid.
Physical therapy and orthopedic appliances (such as splints) may be needed to maximize muscle function and maintain limb position.
Patients may take medication, if necessary, to treat pain or uncomfortable sensations. The response to medications varies. Patients are advised to take the least amount of medication needed to reduce symptoms, to help prevent drug dependence and other side effects of chronic use.
Common medications may include over-the-counter analgesics such as aspirin, ibuprofen, or acetaminophen to reduce pain. Tricyclic antidepressants or anticonvulsant medications may help stabbing pains.
Positioning, or the use of a bed frame that keeps the covers off the legs, may reduce pain for some people.
Some people may need to treat blood pressure problems, difficulty with urination, and slow gastrointestinal movement.
Light-headedness or dizziness when standing up (orthostatic hypotension) may require several different treatments before you find one that successfully reduces symptoms. Treatments that may help include:
- Wearing elastic stockings
- Eating extra salt
- Sleeping with the head elevated
- Using medications such as fludrocortisone
Bladder dysfunction may be treated with:
- Manual expression of urine
- Intermittent catheterization (male or female)
- Medications such as bethanechol
Impotence, diarrhea, constipation, or other symptoms are treated when necessary. These symptoms often respond poorly to treatment in people with alcoholic neuropathy.
It is important to protect body parts with reduced sensation from injury. This may include:
- Checking the temperature of bath water to prevent burns
- Changing footwear
- Frequently inspecting the feet and shoes to reduce injury caused by pressure or objects in the shoes
- Guarding the extremities to prevent injury from pressure
Stop using alcohol to prevent the damage from getting worse. Treatment for alcoholism may include psychiatric therapy social support such as Alcoholics Anonymous (AA), medications, and behavior modification.
Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 446.
Harati Y, Bosch EP. Disorders of peripheral nerves. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 80.