Understanding Alcoholic Neuropathy

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Of the many health consequences of heavy alcohol use, alcoholic neuropathy is one of the most common, and often the least recognizable.

If you have had a long history of heavy alcohol use, you might experience problems with pain, tingling, or balance, and there is a very high likelihood that these problems are signs of alcoholic neuropathy.

Recognizing the Signs and Symptoms of Alcoholic Neuropathy

Signs and symptoms of alcoholic neuropathy include any combination of the following:

  • Deceased ability to detect sensations in the toes, feet, legs, fingers, hands or arms
  • Pain, tingling or other unusual feelings in 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 ability to feel injuries 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. Your nerves play a major role in the sensation and muscle movement of every part of your body. The effects of alcoholic neuropathy are caused by nerve damage and fall into three main categories; decreased sensation, pain/hypersensitivity, and muscle weakness.

Decreased Sensation

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

Among the consequences of reduced sensation include a diminished ability to feel everyday occurrences, such as the uncomfortable sensation that would normally happen when your toes or fingers bump into something, as well as a diminished ability to avoid bumping into things.

This can even mean that, when you have alcoholic neuropathy, you might not notice painful sensations such as your shoes being too tight, or gently striking into a wall or a curb while walking.

Because of the absence of normal pain and discomfort, you are unlikely to readjust your position, which can cause even further injury. Eventually, you may bruise or bleed without realizing it. Sometimes, if you have alcoholic neuropathy, a growing wound may become infected or complicated, remaining unnoticed until it progresses, requiring extensive medical attention.

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 are normally done 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. Similarly, pain in the hands and feet can be quite severe even in the absence of touch, and this is one of the most bothersome aspects of alcoholic neuropathy.

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 manifest as muscle weakness, which results from the 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, as well as trouble controlling bowel and bladder function and sexual dysfunction.

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.

There are no medications that can help improve loss of sensation, recover 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 or decreasing 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.

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).

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.

If your doctor thinks that you might have alcoholic neuropathy, a complete physical and neurological examination involving 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.

Additionally, depending on your medical condition and other illnesses, you might need to have blood tests, urine tests, EMG and NCV or imaging studies of your brain or spinal cord. Characteristic patterns on these tests suggest or support a diagnosis of alcoholic neuropathy, although there is not a definitive test that confirms this condition, and your doctor makes this diagnosis using a combination of all of these results.

Other 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:

What Causes Alcoholic Neuropathy?

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 has an effect on the 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 structure and function of the stomach, the liver and the 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 caused by large amounts of alcohol can be substantial enough to cause major symptoms, such as loss of sensation, weakness, and balance problems. Nerves are among the organs of the body that do not have a resilient ability to regenerate if they are severely damaged, and thus nerve damage may be permanent if the damage has been taking place for a long period of time or if it persists.

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 substance addiction is a disease and that some individuals are born with a tendency to become addicted. 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. There are medications that 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 much as possible.

Source:

Mellion ML, Silbermann E, Gilchrist JM, Machan JT, Leggio L, de la Monte S, Small-fiber degeneration in alcohol-related peripheral neuropathy, Alcohol Clin Exp Res. 2014 Jul;38(7):1965-72

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