Alcoholism

Nerve Pain with Alcoholism

The cause of alcoholic neuropathy is debated. It probably includes both a direct poisoning of the nerve by the alcohol, and the effect of poor nutrition associated with alcoholism. Up to half of all long-term heavy alcohol users develop this condition.  In severe cases, the nerves that regulate internal body functions (autonomic nerves) may be involved.

Risks for alcoholic neuropathy include:

  1. Long-term, heavy alcohol use
  2. Alcoholism that is present for 10 years or more

 Symptoms

  • Numbness in the arms and legs
  • Abnormal sensations; “pins and needles”
  • Painful sensations in the arms and legs
  • Muscle weakness
  • Muscle cramps or muscle aches
  • Heat intolerance, especially after exercise
  • Impotence (in men)
  • Problems urinating
  • Incontinence (leaking urine)
  • Feeling of incomplete bladder emptying
  • Difficulty beginning to urinate
  • Constipation
  • Diarrhea
  • Nausea, vomiting

Additional symptoms that may occur with this disease:

  • Swallowing difficulty
  • Speech impairment
  • Loss of muscle function or feeling
  • Muscle contractions or spasm
  • Muscle atrophy
  • Movement disorders

Note: Changes in muscle strength or sensation usually occur on both sides of the body and are more common in the legs than in the arms. Symptoms usually develop gradually and slowly become worse over time.

Resources

Resources

  • Harati Y, Bosch EP. Disorders of peripheral nerves. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 80.

  • Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine . 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 446.

Treatments

  • Changing footwear
  • Checking the temperature of bath water to prevent burns
  • Common medications may include over-the-counter analgesics such as aspirin, ibuprofen, or acetaminophen to reduce pain. Tricyclic antidepressants or anticonvulsant medications may help stabbing pains.
  • Frequently inspecting the feet and shoes to reduce injury caused by pressure or objects in the shoes
  • Guarding the extremities to prevent injury from pressure
  • Impotence, diarrhea, constipation, or other symptoms are treated when necessary. These symptoms often respond poorly to treatment in people with alcoholic neuropathy.

It is important to protect body parts with reduced sensation from injury. This may include:

  • It is important to supplement the diet with vitamins, including thiamine and folic acid.
  • Light-headedness or dizziness when standing up (orthostatic hypotension) may require several different treatments before you find one that successfully reduces symptoms.

Treatments that may help include:

  • Wearing elastic stockings
  • Eating extra salt
  • Sleeping with the head elevated
  • Using medications such as fludrocortisone

Bladder dysfunction may be treated with:

  • Manual expression of urine
  • Intermittent catheterization (male or female)
  • Medications such as bethanechol
  • Maximizing ability to function independently

Patients may take medication, if necessary, to treat pain or uncomfortable sensations. The response to medications varies. Patients are advised to take the least amount of medication needed to reduce symptoms, to help prevent drug dependence and other side effects of chronic use.

Physical therapy and orthopedic appliances (such as splints) may be needed to maximize muscle function and maintain limb position.

Positioning, or the use of a bed frame that keeps the covers off the legs, may reduce pain for some people.

Some people may need to treat blood pressure problems, difficulty with urination, and slow gastrointestinal movement.

Stop using alcohol to prevent the damage from getting worse. Treatment for alcoholism may include psychiatric therapy social support such as Alcoholics Anonymous (AA), medications, and behavior modification.

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