Alcohol and Neuropathy in Chronic Users

The term neuropathy may refer to several conditions that involve nerve damage and impaired nerve cell signaling within the nervous system.

Often, neuropathy refers to damage or impaired functioning in the peripheral nerves, which are nerves that transmit signals between the brain and spinal cord (i.e., the central nervous system, or CNS) and the periphery (i.e., the rest of the body). Peripheral nerves are responsible for a large number of voluntary and involuntary actions.

Three types of nerves can be involved in neuropathy:

• Motor nerves: These nerves control voluntary movements. Neuropathy in motor nerves may manifest as weakness, particularly in the feet and hands. Over time, motor nerve damage can lead to significant atrophy, or shrinking of skeletal muscles.
• Sensory nerves: These nerves are involved with sensations such as temperature and touch. When these are involved in neuropathy, people may have a diminished ability to detect temperature, vibration, and light touch; people may experience proprioceptive deficits (i.e., decreased sense of position and/or movement of body parts) and impaired reflexes. Neuropathic pain may arise in connection with sensory type peripheral neuropathies.
• Autonomic nerves: These are nerves that control certain involuntary processes, such as those carried out by our cardiovascular, urinary, gastrointestinal, and endocrine systems. Neuropathy here can result in sweating and altered thermoregulation as well as changes in blood pressure and heart rate.

In terms of the extent of any given neuropathy, a single nerve can be affected (a condition known as mononeuropathy) or multiple nerves can be affected (a condition known as polyneuropathy). In addition, combination neuropathies exist in which some combination of the above nerve pathways are affected (potentially all 3).

Causes of Neuropathy

Several medical conditions are associated with the development of peripheral neuropathies—the signs, symptoms, and severity of presentation for which may vary.

• In addition to alcoholism, a very common cause of neuropathy is diabetes and poor blood sugar control. People who have diabetes and consistently elevated blood sugar levels are at increased risk of eventual peripheral nerve damage.
• Various combinations of patterns of neuropathy (e.g., sensorimotor, autonomic) are known to occur in the AIDS stage of HIV infection. Medications used to treat HIV infection may also give rise to a sensorimotor neuropathy.
• Several different medications, including certain cancer chemotherapies are associated with neuropathy.
• Certain malignancies themselves, such as lymphoma, can also lead to neuropathy (i.e., paraneoplastic neuropathy).
• Nutritional deficits, including thiamine, folate, and vitamin B12 deficiency may each lead to different neuropathies.
• Kidney failure may lead to what’s known as uremic neuropathy.
• Toxic exposure to certain herbicides (e.g., dichlorophenoxyacetic acid) and other organic chemical compounds (e.g., acrylamide, ethylene oxide, organophosphates) can result in the development of neuropathy.
• Nerve compression and/or injury, as the result of hemorrhage, penetrating wounds, compartment syndrome, etc. can result in a progressive neuropathy.
• Certain infectious, inflammatory, autoimmune, and hereditary conditions, including familial myelinopathies, rheumatoid arthritis, amyloidosis, sarcoidosis, and systemic lupus erythematosus, are also known to cause neuropathy.
• Nearly a third of people diagnosed with neuropathy are diagnosed with idiopathic neuropathy, meaning that there is no known cause.

Neuropathy Caused by Excess Alcohol Use

Chronic drinking is a common cause of peripheral neuropathy. Alcoholic neuropathy can develop either as a result of the direct neurotoxic effects of alcohol and its metabolites (e.g., acetaldehyde) or in connection with certain drinking-related health issues, such as nutritional deficits and thiamine deficiency. Symptom presentation may vary somewhat for each type, though diminished sensation, paresthesia, burning pain, and sensitized or heightened pain response (primarily in the lower extremities) are common.

Other symptoms associated with alcoholic neuropathy include:

• Numbness.
• Burning.
• Tingling or prickly sensations.
• Distal muscle weakness.
• Gait disturbances.
• Urinary issues such as incontinence, difficulty starting urination, urinary retention, etc.
• Gastrointestinal changes such as persistent diarrhea or constipation.<.li>
  cramps and muscle spasms, a loss of movement, and even muscle atrophy in the arms and legs
• Other potential symptoms associated with alcoholic neuropathy in different body systems, such as sexual dysfunction, difficulty swallowing, speech impairments (slurred speech or dysarthria, which is a condition where speech is difficult to enunciate), reduced tolerance for heat, and dizziness or lightheadedness.

Treating Alcoholic Neuropathy

Some of the primary goals of treatment include:

• Cessation of drinking to prevent worsening of the neuropathy (professional treatment for alcohol use disorder may be needed to achieve this fundamental step).
• Improved nutrition (with vitamin supplementation, when warranted).
• Supportive management of the current neurological symptoms.
• Increased safety measures (e.g., orthopedic aids, special footwear), physical therapy, and rehabilitation to restore as much functioning as possible and decrease the likelihood of injury in cases of neuropathy-mediated functional decline.

The issue with treating neuropathy is that, in many cases, once the nerves are damaged, they may not return to their former level of functioning.

Neuropathic pain may be managed with medications such as gabapentin and amitriptyline as well as acetaminophen, aspirin or other NSAIDs. However, such measures merely address acute discomfort and do nothing to target the underlying pathology or halt disease progression. Though there may be no definitive means of reversing a peripheral neuropathy, the ultimate goal is to address the underlying cause of the neuropathy and prevent further damage while managing the current neuropathy-related issues.

Of course, the core approach to managing neuropathy in individuals who have alcohol abuse problems is to halt the underlying cause of neuropathy. Any person diagnosed with alcoholic neuropathy will be counseled to stop drinking—a process which may be facilitated (as well as made as safe and comfortable as possible) with a supervised medical detox period followed by longer-term alcohol rehabilitation.

All told, a comprehensive prescription for recovery might consist of:

• Medical alcohol detoxification and withdrawal management to comfortably negotiate the withdrawal process, curb cravings, and address any other medical issues that can exacerbate alcohol use.
• A formal treatment program consisting of behavioral counseling and therapy for an alcohol use disorder, as well as access to medical services for any concurrent mental or medical health issues.
• Participation in social support groups, such as Alcoholics Anonymous.
• Aftercare planning and long-term sobriety maintenance.