Alcoholic neuropathy is one of the most common and least recognizable consequences of heavy alcohol use. People with a long history of alcohol misuse might experience pain, tingling, weakness, numbness, or loss of balance as a result of alcoholic neuropathy.
Signs and Symptoms of Alcoholic Neuropathy
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 in the toes, feet, legs, fingers, hands or arms
*Weakness in the feet or hands
*Lack of coordination of the feet or hands
*Loss of balance/unsteadiness when walking
*Bruises, cuts, sores or skin infections on the toes, feet, or fingers
*Decreased pain from injuries, especially on the feet or hands
*Dizziness, particularly when standing with eyes closed
*Trouble walking a straight line, even without recent alcohol use
*Constipation or diarrhea
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.
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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.
Pain and Hypersensitivity
Another 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.
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 nerves control functions of the organs of the body, such as the bladder, stomach, and intestines.2
Alcoholic neuropathy can weaken the autonomic nerves, causing impairment of bowel and bladder function and sexual dysfunction.
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. It is not completely clear why some people are more prone to this complication than others.
Alcoholic neuropathy is caused by nutritional deficiency, as well as toxins that build up in the body. Alcohol decreases absorption of nutrients, such as protein and vitamin B12, causing significant deficits that affect many areas of the body, including the nerves. Alcohol also 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.
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. 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 medical history, physical examination, and possibly blood tests or nerve tests such as electromyography (EMG) and nerve conduction studies (NCV).
Physical examination: A complete physical and neurological examination tests reflexes, muscle strength, sensation (including light touch, pinprick, vibration and position sense), and coordination. 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. 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, only the extent of nerve damage.
Nerve biopsy: In rare instances, a doctor may suggest a nerve biopsy, which can show a pattern of nerve damage consistent with alcoholic neuropathy.
Other tests: Additional assessments might include blood tests, urine tests, or imaging studies of the brain or spinal cord to rule out other causes of neuropathy symptoms.
Treatment of Alcoholic Neuropathy
There are several medical treatments that can be used to manage the pain of alcoholic neuropathy. These include pain medications and antidepressants. While not specifically approved for the treatment of alcoholic neuropathy, antidepressants are often prescribed to help control the pain. Similarly, anti-seizure medications: As with antidepressants are sometimes prescribed as a way to manage pain.
Since nutritional deficiencies are partly to blame for alcoholic neuropathy, 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 in 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 in the symptoms of alcoholic neuropathy after the liver transplant,4 but often, the neuropathy is so advanced that there may be little, if any, improvement, even after a transplant.
Alcohol use disorder is a challenging condition. 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 to managing alcohol use disorder.
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 alcohol consumption as soon as possible.
By Heidi Moawad, MD, and medically reviewed by Huma Sheikh, MD