Excessive alcohol consumption: what is alcoholic peripheral neuropathy?

Alcoholic Peripheral Neuropathy

Alcoholic peripheral neuropathy (ALN) is a condition that damages the nerves in the body due to chronic alcohol consumption. It can cause sensory, motor, and autonomic dysfunction, which can lead to disability. This damage prevents the nerves from communicating information. Most symptoms generally start as mild but typically worsen over time as the neuropathy progresses. The most common symptoms are: (National Library of Medicine, 2023)

• Numbness or tingling sensation in the extremities
• Pain or a burning sensation in the extremities
• Difficulty walking
• Difficulty urinating
• Difficulty talking or swallowing

Affected nerves include the peripheral and autonomic nerves, which help regulate internal body functions. Around 46% of chronic alcohol users will eventually develop the condition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)

Causes

The exact cause of alcoholic neuropathy is unclear. But it is directly related to heavy and long-term alcohol consumption. (Julian T., Glascow N., Syeed R., & Zis P. 2019) It is believed overconsumption of alcohol can directly harm and hinder the nerves’ ability to communicate information. Unhealthy nutritional habits are often associated with it as well. Research shows that decreased thiamine/B vitamin plays a role, while others suggest an overall dietary deficiency may play a role. (Julian T., Glascow N., Syeed R., & Zis P. 2019) However, alcoholic neuropathy can also occur without the presence of malnutrition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)

Neuropathy Development and Progression

Alcoholic peripheral neuropathy develops depending on many factors, including the amount of daily/nightly alcohol consumed, age and overall health, nutritional intake, and other individual factors. In most cases, the neuropathy takes several years or decades to develop, depending on the amount of alcohol consumed.

Symptoms

Symptoms are usually related to nerve dysfunction and include: (National Library of Medicine, 2023)

• A tingling or pins-and-needles sensation in the extremities.
• Numbness of the extremities, most commonly in the legs or feet. (Julian T., Glascow N., Syeed R., & Zis P. 2019)
• Pain or burning sensation in the arms, legs, or feet.
• Symptoms that occur in the arms and legs typically affect both sides.
• Cramps, aches, or weakness of the muscles.
• Constipation or diarrhea.
• Nausea and vomiting.
• Difficulty urinating or incontinence.
• Difficulty walking.
• Difficulty talking or swallowing.
• Heat intolerance.
• Erection difficulties.

Most symptoms begin as mild and usually worsen over time as the neuropathy progresses. Alcoholic neuropathy affects individuals who consume excessive amounts of alcohol over a long time. (Julian T., Glascow N., Syeed R., & Zis P. 2019)

Diagnosis

Symptoms can vary significantly so that a diagnosis may take time. It usually involves a combination of the following (National Institute of Neurological Disorders and Stroke, 2024)

Medical History

• Healthcare providers will collect data involving past medical history and all current symptoms.

Physical Exam

• This exam looks at other medical conditions contributing to symptoms, like diabetes or high blood pressure.

Neurological Exam

• This is a noninvasive exam to determine the location and extent of neurological damage.
• Healthcare providers may ask patients several questions and have them complete a series of small movements to check neurological function.

Blood and Urine Tests

• These tests can detect diabetes, liver and kidney problems, infections, vitamin deficiencies, and other conditions that can cause neuropathic conditions.

Chronic alcohol use can also affect how the body stores and uses vitamins necessary for healthy nerve function. Vitamin levels that a healthcare provider may check include: (National Library of Medicine, 2023)

• Vitamin A
• Biotin
• Folic acid
• Niacin, or vitamin B3
• Pyridoxine, or vitamin B6
• Pantothenic acid

Liver Disease

Individuals with chronic liver disease often have neuropathy. The severity and stage are associated with a higher incidence of neuropathy. (Pasha MB, Ather MM, Tanveer MA, et al. 2019)

Treatment

Alcoholic neuropathy is not reversible, even when quitting drinking. However, individuals with the condition can make healthy changes to minimize symptoms and receive help for chronic alcohol use. The first step is stopping alcohol consumption. (Chopra K., & Tiwari V. 2012) Talk to a healthcare provider about what options are available. Treatment can include:

• In-patient or outpatient rehab
• Therapy
• Medication
• Social support from groups like Alcoholics Anonymous

A combination of treatments will likely be utilized. Other treatment options involve symptom management and preventing further injuries and may include:

• Physical therapy
• Keeping the head elevated while sleeping.
• Orthopedic splints to maintain limb function and positioning.
• Wearing compression stockings.
• Adding vitamins and supplements.
• Eating extra salt for those without hypertension
• Medications to reduce pain and discomfort.
• Intermittent catheterization or manual expression of urine for those with difficulty urinating.

Individuals with neuropathy may have reduced sensitivity in the arms and legs. If this occurs, additional steps need to be taken to prevent other injuries, that include (National Library of Medicine, 2023)

• Wear special footwear to prevent foot injuries.
• Checking feet daily for wounds.
• Prevent burns by ensuring that bath and shower water is not too hot.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

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Peripheral Neuropathy Myths and Facts

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References

National Library of Medicine. (2023). Alcoholic neuropathy. Retrieved from medlineplus.gov/ency/article/000714.htm

Julian, T., Glascow, N., Syeed, R., & Zis, P. (2019). Alcohol-related peripheral neuropathy: a systematic review and meta-analysis. Journal of Neurology, 266(12), 2907–2919. doi.org/10.1007/s00415-018-9123-1

National Institute of Neurological Disorders and Stroke. (2024). Peripheral neuropathy. Retrieved from www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy

Pasha MB, A. M., Tanveer MA, et al. (2019). Frequency of peripheral neuropathy in chronic liver disease. Med Forum Monthly, 30(8), 23-26. medicalforummonthly.com/index.php/mfm/article/view/3761

Chopra, K., & Tiwari, V. (2012). Alcoholic neuropathy: possible mechanisms and future treatment possibilities. British journal of clinical pharmacology, 73(3), 348–362. doi.org/10.1111/j.1365-2125.2011.04111.x