Understanding Alcoholic Neuropathy

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Alcoholic neuropathy is one of the most common and least recognizable consequences of heavy alcohol use. If you have had a long history of heavy alcohol use, you might experience pain, tingling, weakness or loss of balance as a result of alcoholic neuropathy.

Signs and Symptoms

Signs and symptoms of alcoholic neuropathy can progress gradually, and they are usually subtle at first. Often, a person who drinks heavily might not recognize that the symptoms are related to alcohol or to neuropathy.

Signs and symptoms include any combination of the following:

  • Deceased sensation of the toes, feet, legs, fingers, hands or arms
  • Pain, tingling or other unusual feelings of the toes, feet, legs, fingers, hands or arms
  • Weakness of the feet or hands
  • Lack of coordination of the feet or hands
  • Loss of balance/ unsteadiness when walking
  • Bruises, cuts, sores or infections of the skin on the toes, feet, or fingers
  • Decreased pain from injuries, especially on the feet or hands
  • Dizziness, particularly when standing with your eyes closed
  • Trouble walking a straight line, even if you have not been drinking
  • Constipation or diarrhea
  • Urinary incontinence
  • Sexual dysfunction

Effects of Alcoholic Neuropathy

Alcoholic neuropathy is a nerve disease caused by excessive alcohol consumption over a long period of time. The effects of alcoholic neuropathy are caused by nerve damage and fall into four main categories; decreased sensation, pain/hypersensitivity, muscle weakness, and autonomic.

Decreased Sensation

Alcoholic neuropathy damages sensory nerves, resulting in decreased sensation of the hands and feet. This may not sound like a terrible problem, but diminished sensation actually causes very serious consequences.

  • Frequent Bumps and Scrapes: Among the consequences of reduced sensation include a diminished ability to feel pain that would normally result from everyday minor injuries. You might not detect an uncomfortable sensation that should normally happen when your toes or fingers bump into something, which essentially makes it more likely that you will bump into things. You might not notice painful sensations such as your shoes being too tight, or gently striking into a wall or a curb while walking.
  • Infections and Bleeding: Because of the absence of normal pain and discomfort, you are unlikely to protect tender sores and wounds, which can cause even further injury. Eventually, your wounds may bleed or become infected,
  • Diminished Sensory Skills: Another consequence of decreased sensation is the inability to properly balance and coordinate fine motor skills, such as walking and finger movements. We rely on the sensation in our feet to effortlessly walk without looking down at the ground. With diminished sensation, activities that you normally do without looking, such as walking, writing, and typing, can become impaired. Often, advanced alcoholic neuropathy can make you feel off balance, particularly when you shut your eyes, as you would in the shower, and this can lead to dangerous falls.

    Pain and Hypersensitivity

    The other prominent effect of alcoholic neuropathy involves painful and uncomfortable sensations. Alcoholic neuropathy can result in hypersensitivity to touch and/or resting pain. Light touch can feel exaggerated and painful, particularly in the fingers and toes.

    Constant pain in the hands or feet is one of the most bothersome aspects of alcoholic neuropathy. The pain can feel like burning, throbbing or sharp pins and needles. As the condition progresses, the pain may vary in intensity, sometimes diminishing for months at a time before worsening again.

    Muscle Weakness

    Severe alcoholic neuropathy may cause motor weakness due to nerve damage. Our muscles need to receive a message from nearby nerves in order to function. When this message is interrupted due to damaged nerves, the muscles cannot function as they normally would. This most often manifests with weakness of the hands and feet.

    Autonomic Neuropathy

    Autonomic nerves control functions of the organs of the body, such as the bladder, stomach, and intestines. Alcoholic neuropathy can weaken the autonomic nerves, causing impairment of bowel and bladder function and sexual dysfunction.

    Causes

    In general, it takes years for alcoholic neuropathy to develop, so a long-standing history of heavy alcohol use is typical. Some heavy alcohol users experience a faster onset and progression of alcoholic neuropathy than others, and it is not completely clear why some people are more prone to this complication than others.

    Alcoholic neuropathy is caused by nutritional deficiency related to long term heavy alcohol consumption, as well as toxins that build up in the body as a result of long-term heavy alcohol consumption.

    Alcohol decreases absorption of nutrients, such as protein and vitamin B12, and causes significant nutritional deficits that impact many areas of the body, including the nerves. In addition, alcohol alters the function of the stomach, liver, and kidneys in ways that prevent the body from properly detoxifying waste material, which then builds up and harms many regions of the body, including the nerves.

    The nerve damage typically affects the axons, which are the projections that send electrical signals from one nerve to another, as well as the myelin, which is the fatty coating that protects the nerves. Nerves do not have a resilient ability to regenerate if they are severely damaged, and the nerve damage of alcoholic neuropathy may be permanent if the damage has been taking place for a long period of time or if it persists.

    Diagnosis of Alcoholic Neuropathy

    The diagnosis of alcoholic neuropathy involves a combination of your medical history, your physical examination, and possibly blood tests or nerve tests such as electromyography (EMG) and nerve conduction studies (NCV).

    • Physical examination: If your doctor thinks that you might have alcoholic neuropathy, a complete physical and neurological examination testing your reflexes, muscle strength, a detailed examination of your sensation (including light touch, pinprick, vibration and position sense), and testing of your coordination would be completed at your doctor’s office.Usually, people with alcoholic neuropathy have diminished reflexes, and diminished sensation. In very advanced disease, weakness may be present too.
    • Electromyography (EMG) and nerve conduction studies (NCV): These tests examine nerve function in detail and characteristic patterns, such as decreased function in the hands and feet, low amplitude of nerve waves, and slowing of nerve function are suggestive of alcoholic neuropathy. The nerve tests do not identify the cause of neuropathy however, just the extent of nerve damage.
    • Nerve biopsy: In rare instances, a nerve biopsy may be needed, which can show a pattern of nerve damage consistent with alcoholic neuropathy.
    • Other tests: You might need to have blood tests, urine tests, or imaging studies of your brain or spinal cord to rule out other causes of your symptoms.

    Conditions That May Mimic Alcoholic Neuropathy

    There are a number of other medical conditions that can be confused with alcoholic neuropathy. The most common of these include:

    Treatment of Alcoholic Neuropathy

    There are several medical treatments that can be used to manage the pain of alcoholic neuropathy. These include:

    • Pain medications 
    • Antidepressant medications: While not specifically approved for the treatment of alcoholic neuropathy, they are often prescribed to help control the pain.
    • Anti seizure medications: As with antidepressants, these medications are not formally indicated for the treatment of alcoholic neuropathy, but they are sometimes prescribed as a way to manage the pain.
    • Vitamin supplements: Nutritional deficiencies are partly to blame for alcoholic neuropathy, and supplementation with vitamin B12, folate, Vitamin E, and thiamine may be recommended.

    There are no medications that can help improve loss of sensation, strengthen the muscle weakness, or aid the coordination and balance problems caused by alcoholic neuropathy. However, some people notice an improvement of symptoms a few months after discontinuing alcohol intake.

    Sometimes alcohol causes such severe damage to the body that a liver transplant may be necessary. In that case there may be some improvement of the symptoms of alcoholic neuropathy after the liver transplant, but often, the neuropathy is so advanced that there may be little, if any, improvement, even after a transplant.

    A Word From Verywell

    Alcoholism is a challenging disease. Most people who have successfully managed alcoholism did not do it alone. The medical community has recognized that addiction is a disease, and that some individuals are born with a tendency to become addicted to substances. Thus, it is usually necessary to get medical help when managing an addiction such as alcoholism.

    Some of the symptoms of alcoholic neuropathy can be partially reversed, but if the neuropathy becomes advanced, it might not be reversible. Medication can help in reducing some of the symptoms of alcoholic neuropathy. The most important strategy against alcoholic neuropathy lies in preventing the symptoms from getting worse by decreasing your alcohol consumption as soon as possible.

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