What is Alcoholic Neuropathy & Can it be Reversed?

Many people wonder as to what is alcoholic neuropathy and can it be reversed? Alcoholic neuropathy is a condition in which the peripheral nerves get damaged, mostly due to excessive drinking of alcohol. It is a type of peripheral neuropathy occurring in alcoholics and the symptoms of alcoholic neuropathy can be identified by increasing its awareness. It is important to understand the causes and symptoms of alcoholic neuropathy to begin with timely treatment. Recovery in alcoholic neuropathy can be expected in most cases, which receive timely treatment. Alcoholic neuropathy can be reversed in some cases, with proper management and treatment.

In alcoholic neuropathy, the peripheral nervous system gets damaged, most probably due to alcohol abuse, as alcohol can be toxic for the nerves. Peripheral nerves carry signals from the body to the brain and spinal cord and bring signals back to the body. Neuropathy severely affects the way the nerves send signals to or receive from the brain. As a result of this, there are changes in the way the nerves sense the signals, which results in pain or alteration in sensations. Peripheral nerves supply the peripheral areas, which include the limbs or extremities. Hence, the common areas affected in alcoholic neuropathy include the arms, hands, fingers, legs, feet and toes, but internal functions can also get affected. Recovery from and reversal of alcoholic neuropathy is possible when the causes are promptly treated and a proper management is planned.

A common question coming to one’s mind is, ‘can alcoholic neuropathy be reversed?’ To be able to understand this, it is important to understand the way alcoholic neuropathy affects a person, its causes, symptoms, treatment and recovery. While some cases may respond very well to prompt treatment and show satisfactory recovery, some cases with extensive and severe nerve damage may be more challenging.

While the exact cause of alcoholic neuropathy is not clearly known, alcohol can play a role in causing nerve damage. Peripheral neuropathy is more commonly seen in alcoholics and alcoholic neuropathy is believed to be related to the overuse of alcohol. Alcohol may be acting as a toxic substance that can be involved in causing damage to the nerve fibres. Also faulty eating habits and poor nutrition is often associated with excessive alcohol drinking, which may also damage the nerves.

Certain risk factors have been identified that may increase the risk of alcoholic neuropathy. These mainly include

• Heavy alcohol use or people drinking in large quantities for a long time.
• Diabetics are also at increased risk of experiencing peripheral neuropathy and is accompanied with heavy drinking, may increase the chances of alcoholic neuropathy as well.
• People with poorly controlled blood sugar levels and those having diabetes for a number of years are at greater risk of alcoholic neuropathy.
• With aging, people normally tend to be more susceptible to various medical conditions and nerve damage can be one of them. Excessive drinking with increasing age can increase the risk of alcoholic neuropathy.

Vitamin and nutrition deficiency is also believed to play an important role in maintaining nerve health. Vitamin B6, B12, B complex in general and folic acid, have known to be beneficial nutrients for nerve development. If a person is deprived of these nutrients or experiences conditions that cause nutritional or vitamin depletion, it increases their chances of alcoholic neuropathy. Alcoholics are likely to experience both effect of alcohol and nutritional deficiency causing nerve damage, which is a major symptom of alcoholic neuropathy.

People who suffer from peptic ulcers or other digestive problems, which may require the use of antacids or proton-pump inhibitors can sometimes have greater risk of neuropathies. Use of antacids and other medicines for a longer period can affect the normal absorption of vitamins and nutrients, essential for nerve building. This can lead to deficiency of vitamin B12 and other essential nutrients, which can increase the risk of alcoholic neuropathy.

Other factors include previous nerve damage, injuries or medical conditions that have caused nerve problems, neuropathies or nerve related complaints. Such people may be at increased risk of alcoholic neuropathy, if clubbed with alcohol abuse. Some people with thyroid, kidney or liver disorders, autoimmune conditions or those exposed to prolonged stress can be at risk of alcoholic neuropathy.

Alcoholic neuropathy presents with all the symptoms of peripheral neuropathy but is often associated with heavy drinking. The main symptoms of alcoholic neuropathy revolve around affected nerve sensations and functions. Most of the complaints experienced in alcoholic neuropathy are quite annoying, debilitating and painful. Symptoms of alcoholic neuropathy usually affect hands and legs and can be seen on one or mostly, both sides.

Common symptoms of alcoholic neuropathy include

In most cases of alcoholic neuropathy, pain in the hands or legs is a common complaint. Pain is often felt in the arms, hands and may extend up to the fingers. Similarly pain may also be felt in the legs and may extend to the feet. Sometimes, pain may be felt as painful cramps in the muscles of extremities. Muscle spasms and twitching may also be increased in the arms and legs.

Another common symptom of alcoholic neuropathy is increased sensitivity to pain, touch or temperature changes. People may feel the pain in hands and legs with the slightest pressure or even touch. Many people feel excess pain with exposure to cold due to increased sensitivity in alcoholic neuropathy. Similarly, many may also feel intolerant to heat, particularly when exposed to warm areas or after exercise.

The commonest symptoms of alcoholic neuropathy include numbness and tingling sensation in the hands and feet. It is often described as ‘pins and needles’ and is felt as many pins were pricking in the area. Some may also feel a burning sensation along the course of the nerve on the hands or legs. Numbness can make the whole arm, hand or feet feel as if it were dead and could not be moved. Some may also feel dizziness, loss of balance and lack of co-ordination in movements, as symptoms of alcoholic neuropathy. It is common for people to experience movement disorders, which feel similar to motion sickness or a sick feeling when moving around. Some may even feel nauseated due to movement or may feel as they were about to fall when moving.

Motor symptoms of alcoholic neuropathy include those signs and symptoms which show functional changes in the performance of the affected areas. Although alcoholic neuropathy causes damage to the peripheral nerves, these nerves mainly supply the limbs, hence they are affected the most. The hands and legs may feel pain along with complaints of the muscle. Many people experiencing alcoholic neuropathy may show muscle weakness, affected functioning of the muscles and even cause loss of muscle mass or muscle atrophy.

Just like the extremities, alcoholic neuropathy can also affect the internal organs and other body parts. Some common symptoms of alcoholic neuropathy include urinary incontinence, problems when urinating, feeling as if bladder is not completely emptied or difficulty to begin with urination. Some may also experience constipation or diarrhea or alternate changes in the bowel patterns. As these functions are mainly controlled by the nervous system, damage caused to the nerves can affect these functions as well.

Alcoholic neuropathy can affect the entire functioning of the body. Some may experience pain or discomfort more in the night, making it difficult to fall asleep or sleep well during the night. Other functions like talking, swallowing or speech difficulty may also get affected in some cases. Symptoms of alcoholic neuropathy can also include difficulty in ejaculation, erectile dysfunction or affected sexual function.

Thus, the symptoms of alcoholic neuropathy can affect various areas and although the condition may not be serious, it can surely affect the quality of life. While proper treatment of alcoholic neuropathy can help recovery, if the condition is left unattended, symptoms may worsen with increasing time and age.

Diagnosis of alcoholic neuropathy can be made on the basis of personal history, clinical examination and some laboratory tests. Investigations may also be done to rule out other underlying conditions or those disorders causing neuropathies or have similar symptoms.

Patient’s history is important to analyze the social habits, work environment, dietary habits, history of alcoholism and family history of diabetes or neurological disease. History of complaints, the nature, onset and the progress of symptoms and history of past or present medical conditions, injuries, surgeries or medications taken must be noted.

Clinical examination and neurological tests must be conducted for the evaluation of muscle strength, increased sensitivity, ability to register pain, touch and other senses, presence of cramps and twitching of muscles. Muscle functioning and control, muscle weakness is also tested to understand the condition.

Some investigations for alcoholic neuropathy may be ordered. These include

Blood investigations

• Blood tests for blood glucose level, Haemoglobin A1c to detect diabetes and blood glucose level control.
• Bloods tests for vitamins and other nutrients, vitamin B12, folic acid and thiamine to detect nutritional deficiencies. Electrolyte level may also be checked.
• Test for thyroid profile, liver enzyme levels, CBC & ESR to detect alcoholism and other inflammatory causes of neuropathy.

Other investigations to confirm diagnosis of alcoholic neuropathy include

• Nerve Studies like nerve conduction studies (NCS) and electromyography (EMG), which help to study the characteristics of neuropathy, localization and extent.
• Other invasive tests like nerve biopsy and skin biopsy can help to detect the degree of nerve damage.
• Other investigations like CT scan, MRI, Nuclear imaging, Doppler imaging and micro dialysis may be done to rule out other causes.
• Latest advance tests to aid diagnosis of alcoholic neuropathy are also available, which include indicator plaster neuropad, skin punch biopsy and quantitative sensory testing.

The major complications of alcoholic neuropathy occur due to altered sensations. Diminished sensations of pain, touch and temperature changes increase the risk of injuries, infected wounds, burns and skin trauma. Balance and co-ordination problems can be dangerous in outdoor activities and can cause injuries.

Basic management aims at

• Maintaining blood glucose levels within limits to avoid further damage to the nerve.
• Counseling and rehabilitation for alcoholics. Some may need hospitalization and extensive work for de-addiction.
• Any underlying cause like medical conditions, nerve injuries, conditions causing nerve compression, etc. must be promptly treated.

In some cases, damage to the nerves in alcoholic neuropathy can cause permanent changes, however, in some cases, proper planning, removal of the main cause and appropriate treatment can help to reverse alcoholic neuropathy.

Alcoholic neuropathy is mainly related to excessive alcohol consumption and when signs and symptoms of alcoholic neuropathy are seen or when the conditions is diagnosed, the first step is to cut back on alcohol intake. Completely stopping alcohol consumption and following medical advice can help the person recover from the condition.

Successful treatment of alcoholic neuropathy is possible in cases, which are detected in time and are less complicated with other problems. Damage to the nerves continues to increase unless it is treated, early detection and intervention can help to reverse alcoholic neuropathy in most uncomplicated cases. Hence, it is important to evaluate the extent to which the nerve is damaged and the severity of symptoms.

As nerve cells can be regenerated, medicines and proper care can be taken to regenerate them and improve their function, which can help to reverse alcoholic neuropathy. However, considering their limited ability to regenerate, if the nerves are severely damaged or almost lost all their strength, their recovery may also be limited and may take longer time.

The prognosis of alcoholic neuropathy can be better in cases, which are mildly affected or have just began to cause nerve damage, than those with serious nerve damage. Also, other factors like the underlying cause of the condition is very important in considering whether alcoholic neuropathy can be reversed or not. Some patients with several complications and extensive nerve damage may show recovery only to a certain extent as against those with lesser or no complications.

Reversal of alcoholic neuropathy is possible only if the underlying cause is treated and the progression of disease is stopped. For this, alcohol must be completely eliminated from the diet, the nutritional deficiencies must be corrected, symptoms must be brought under control and rehabilitation must be focused on. Therapeutic program and proper diet with vitamin rich nutrients must be planned. Controlled blood sugar levels, treatment of nerve injuries and stress management is also required.

Heavy drinkers may find it difficult to cope but controlling alcohol consumption and co-operating with medical advice is required. Person’s compliance to treatment and consumption of alcohol is very crucial in the recovery process. Most persons who follow medical advice well and continue with rehabilitation program as advised show better chances of recovery from alcoholic neuropathy. People in whom the disease progression is not advanced, alcoholic neuropathy can be reversed, but it may take few weeks to months with continuous support.

Alcohol being a main contributing factor in alcoholic neuropathy, it is important to control alcohol consumption. Controlling blood glucose levels is equally essential to lower the risk. Any conditions, which can affect the nerves must be treated in time to avoid further nerve damage and increased risk of alcoholic neuropathy. Educate patients to maintain healthy lifestyle, eat healthy food with regular exercise, to follow prescribed medications and appropriate measures for reduced pain or sensations.