Alcohol-Related Neuropathy / Polyneuropathy

What is Alcohol-Related Neuropathy / Polyneuropathy?

Alcohol use disorders can sometimes result in alcohol-related neuropathy / polyneuropathy, the simultaneous malfunction of multiple peripheral nerves, leading to nerve dysfunction, resulting in pain and motor weakness. This is caused by a toxic effect from the alcohol on the nerves. 

Habitual heavy use of alcohol is also associated with poor nutrition, resulting in severe vitamin deficiencies that can contribute to peripheral neuropathies. For example, thiamine (vitamin B1¹) deficiency can cause widespread damage to nerve tissue.

What are the symptoms?

Alcohol-related neuropathy develops gradually and symptoms may not be present early on. Weight loss is sometimes considered an early warning sign of the condition, particularly in cases linked to alcohol use disorders. As the disease develops, sensory and motor loss are typically cited symptoms. The degree of these symptoms range from almost undetectable to more severe instances of physical disability.   

Reported sensory symptoms include numbness or pain in the limbs, ‘pins and needles’ sensations and heat intolerance. Individuals with alcohol-related neuropathy often cite tenderness, pain or cramping in their feet, calves and legs. The degree and persistence of the pain is related to severity of the condition. The location of symptoms can often appear in what is called a ‘glove and stocking’ distribution, with the hands, feet and calves/legs being affected.

The motor system is also affected as the condition develops, causing muscle cramping and weakness. Urinary problems, constipation, and erectile dysfunction (in men) are all potential symptoms of alcohol-related neuropathy. Individuals may also experience frequent falls, problems walking and problems with swallowing or speaking.  

Is there any treatment?

Abstaining from alcohol is critical to managing the symptoms pertaining to alcohol-related neuropathy and to preventing the disease from progressing. Physical therapy, nutritional therapy and pharmaceuticals have all been used to treat patients with alcohol-related neuropathy. 

Physical therapy is often used to help rebuild muscles that may have been lost to degradation and to help build up the patients strength. 

Nutritional therapy and diet are important because of the role vitamin deficiency plays in the development of this condition. Vitamin supplements, particularly thiamine or B12, can assist with recovery. 

Antidepressants, anticonvulsants, and topical analgesics have all been used in the management of pain associated with alcohol-related neuropathy. 

What is the prognosis?

The prognosis for a patient facing alcohol-related neuropathy is challenging to assess due to complications of addiction and alcoholism. For patients with mild alcohol-related neuropathy, who are able to abstain from alcohol for 3-5 years, a good prognosis is possible. Once proper nutrition is re-established, many patients experience significant improvement in their symptoms. For patients dealing with more advanced alcohol-related neuropathy, some of the nerve damage may be permanent and symptoms may persist. 

Related evidence

Mellion M, Gilchrist JM, de la Monte S. Alcohol-related peripheral neuropathy: nutritional, toxic, or both? Muscle Nerve. 2011 Mar;43(3):309-16. doi: 10.1002/mus.21946.

Chopra K, Tiwari V. Alcoholic neuropathy: possible mechanisms and future treatment possibilities. Br J Clin Pharmacol. 2012 Mar;73(3):348-62. doi: 10.1111/j.1365-2125.2011.04111.x.

Ang CD, Alviar MJM, Dans AL, Bautista-Velez GGP, Villaruz-Sulit MVC, Tan JJ, Co HU, Bautista MRM, Roxas AA. Vitamin B for treating disorders of the peripheral nerves. Cochrane Summaries. Published Online 2008 Oct.