This activity describes the evaluation and management of alcoholic neuropathy and reviews the role of the interprofessional team in improving care for patients with this condition. Treatment of ALN aims to reduce further damage to the peripheral nerves alcohol neuropathy and restore their normal functioning. What is crucial during ALN treatment is the alleviation of the major causation of ALN which is alcohol abuse. Alcohol abuse treatment might lead to a resolution of neuropathic pain and alleviation of its symptoms.
Direct toxic effects of ethanol or its metabolites (direct toxicity)
- When this message is interrupted due to damaged nerves, the muscles cannot function as they normally would.
- The medical community has recognized that addiction is a disease and some people are predisposed to it.
Alcoholic neuropathy is caused by nutritional deficiency, as well as toxins that build up in the body. Alcohol decreases the absorption of nutrients such as magnesium, selenium, and vitamins B1 and B2, causing significant deficits that affect many areas of the body, including the nerves. During the initial stages of ALN, the disease may appear asymptomatic and demonstrable only on electroneurographic investigation [71, 111, 112]. Because ALN is a length-dependent https://ecosoberhouse.com/ axonopathy, it manifests mainly in a “stocking-glove” form, affecting the lower extremities at the beginning [28, 113]. The main symptoms of ALN include dysesthesia, paresthesia, numbness, and pain in the lower extremities which progressively reach higher parts of the body [114,115,116,117]. The pain is described as burning, cramp-like, or itching; also, a common symptom is a subjective feeling of cold in both feet [118,119,120,121,122,123].
Is alcoholic neuropathy fatal?
Recently, extended release gabapentin relieved symptoms of painful polyneuropathy [120]. Lamotrigine was effective in relieving central post stroke pain [121] and painful diabetic polyneuropathy [122], but recent larger studies have failed to show a pain relieving effect in mixed neuropathic pain [123] and painful polyneuropathy [124]. Valproate demonstrated varying effects in different studies of neuropathic pain, with three studies from one group reporting high efficacy [125–127] and others failing to find an effect [128, 129].
The role of inflammation
The percentage of alcohol-dependent patients affected by ALN is estimated to be 66% [50, 51]. The pathophysiology of ALN involves underlying mechanisms that include direct or indirect effects of alcohol metabolites, impaired axonal transport, suppressed excitatory nerve pathway activity, or imbalance in neurotransmitters [52,53,54]. An essential risk factor regarding the etiology of ALN is the amount of alcohol consumed throughout the years since alcohol displays direct toxicity on nerve fibers [55]. It is estimated that consumption of more than 100 ml of ethyl alcohol per day significantly increases the risk of ALN [56]. Recent studies show contradictory information about the role of malnutrition and micronutrients (thiamine) deficiency in the pathogenesis of ALN; however, it is assumed that these might induce the progression of ataxia or movement disorders [55, 57].
Indeed, these factors contribute to the progression of ALN symptoms; however, they do not constitute direct factors that manifest in ALN development [84]. Current postulation holds that dysfunctions within the central and peripheral nervous system are due to both direct and indirect toxic effects of alcohol [31, 85,86,87]. Indirect effects are mainly induced by vitamin deficiencies (B1, B2, B3, B5, B6, B7, B9, and B12) [84, 88]. Deficiency of vitamins other than thiamine may also contribute to clinical features of alcoholic neuropathy.
What are the symptoms of alcoholic neuropathy?
However, severe alcohol-related neuropathy may cause permanent nerve damage. However, nerve damage is sometimes permanent, and your symptoms are likely to worsen if you don’t stop drinking. This could lead to disability, chronic pain, and damage to your arms and legs. However, researchers have found that consuming too much alcohol for long periods of time can damage the peripheral nerves. Over time, the effects of drinking too much alcohol may cause alcoholic neuropathy. This condition is also referred to as “alcohol-related neuropathy” to help decrease the stigma surrounding the condition.
According to a 2017 review, muscle myopathy is common in alcohol use disorder. In addition, about 40 to 60 percent of people who experience chronic alcohol misuse also experience alcohol-related myopathy. Researchers have not determined if this is caused by the effects of alcohol on the brain or is the result of thiamine deficiency. Alcoholic neuropathy is progressive damage to peripheral nerves and, in extreme cases, the autonomic nervous system, through chronic, heavy alcohol use. Tricyclic antidepressants (TCAs) are often the first line drugs to alleviate neuropathic pain symptoms.