Alcoholic Neuropathy: Symptoms, Causes, & Treatments

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What Is Alcoholic Neuropathy?

Alcoholic neuropathy is a condition in which the nerves become damaged as a result of years of heavy alcohol consumption. Symptoms of the condition include burning pain in the body, hyperalgesia (increased sensitivity to pain), and allodynia (a condition in which normal stimulus, like a soft touch, produces pain).

Both the toxicity of alcohol and nutritional deficiencies in those who drink heavily have been linked with the nerve pain in alcoholic neuropathy.

Alcoholic neuropathy is one of the most common but least recognizable consequences of heavy alcohol use. People with a long history of alcohol misuse might experience pain, tingling, weakness, numbness, or loss of balance as a result of alcoholic neuropathy.

Signs and Symptoms of Alcoholic Neuropathy

Signs and symptoms of alcoholic neuropathy can progress gradually, and they are usually subtle at first. Often, a person who drinks heavily might not recognize that the symptoms are related to alcohol. Signs and symptoms include any combination of the following:

  • Bruises, cuts, sores, or skin infections on the toes, feet, or fingers
  • Constipation or diarrhea
  • Decreased pain from injuries, especially on the feet or hands
  • Decreased sensation of the toes, feet, legs, fingers, hands, or arms
  • Dizziness, particularly when standing with eyes closed
  • Lack of coordination of the feet or hands
  • Loss of balance/unsteadiness when walking
  • Pain, tingling, or other unusual feelings in the toes, feet, legs, fingers, hands, or arms
  • Sexual dysfunction
  • Trouble walking a straight line, even without recent alcohol use
  • Urinary incontinence
  • Weakness in the feet or hands

Effects of Alcoholic Neuropathy

Alcoholic neuropathy is a nerve disease caused by excessive alcohol consumption over a long period of time. The effects of alcoholic neuropathy are caused by nerve damage and fall into four main categories: decreased sensation, pain/hypersensitivity, muscle weakness, and autonomic.

Decreased Sensation

Alcoholic neuropathy damages sensory nerves, resulting in decreased sensation of the hands and feet. This may not sound like a terrible problem, but diminished sensation actually causes very serious consequences, including:

  • Frequent bumps and scrapes:A diminished ability to feel pain that would normally result from everyday minor injuries can make these injuries more likely.
  • Infections and bleeding: Because of the absence of normal pain and discomfort, tender sores and wounds may be left unprotected, which can cause even further injury. Eventually, wounds may bleed or become infected.
  • Diminished sensory skills: The inability to properly balance and coordinate fine motor skills, such as walking and finger movements, can impair common activities such as walking, writing, and typing. Advanced alcoholic neuropathy can result in feeling off-balance, particularly with eyes closed, which can lead to dangerous falls.

Pain and Hypersensitivity

Another prominent effect of alcoholic neuropathy involves painful and uncomfortable sensations. Alcoholic neuropathy can result in hypersensitivity to the touch and even resting pain. Light touch can feel exaggerated and painful, particularly in the fingers and toes.

Constant pain in the hands or feet is one of the most bothersome aspects of alcoholic neuropathy. The pain can feel like burning, throbbing, or sharp pins and needles. As the condition progresses, the pain may vary in intensity, sometimes diminishing for months at a time before worsening again.

Muscle Weakness

Severe alcoholic neuropathy may cause motor weakness due to nerve damage. Our muscles need to receive a message from nearby nerves in order to function. When this message is interrupted due to damaged nerves, the muscles cannot function as they normally would. This most often manifests with weakness of the hands and feet.

Autonomic Neuropathy

Autonomic nerves control functions of the organs of the body, such as the bladder, stomach, and intestines. Alcoholic neuropathy can weaken the autonomic nerves, causing impairment of bowel and bladder function, and sexual dysfunction.

Causes of Alcoholic Neuropathy

In general, it takes years for alcoholic neuropathy to develop, so a long-standing history of heavy alcohol use is typical. Some people experience a faster onset and progression of alcoholic neuropathy than others. It's not completely clear why some people are more prone to this complication than others.

Alcoholic neuropathy is also caused by nutritional deficiency, as well as toxins that build up in the body. Alcohol decreases the absorption of nutrients, such as protein and vitamin B12, causing significant deficits that affect many areas of the body, including the nerves.

Alcohol also alters the function of the stomach, liver, and kidneys in ways that prevent the body from properly detoxifying waste material, which then builds up and harms many regions of the body, including the nerves.

Nerve damage typically affects the axons, which are the projections that send electrical signals from one nerve to another, as well as the myelin, which is the fatty coating that protects the nerves.

Nerves don't have a resilient ability to regenerate if they are severely damaged. The nerve damage of alcoholic neuropathy may be permanent if the damage has been taking place for a long period of time or if it persists.

Diagnosing Alcoholic Neuropathy

The diagnosis of alcoholic neuropathy involves a combination of medical history, physical examination, and possibly blood tests or nerve tests such as electromyography (EMG) and nerve conduction studies (NCV).

  • Physical examination:A complete physical and neurological examination tests reflexes, muscle strength, sensation (including light touch, pinprick, vibration, and position sense), and coordination. Usually, people with alcoholic neuropathy have diminished reflexes and diminished sensation. In very advanced disease, weakness may be present too.
  • Electromyography (EMG) and nerve conduction studies (NCV):EMG and NCV tests examine nerve function in detail. Characteristic patterns, such as decreased function in the hands and feet, low amplitude of nerve waves, and slowing of nerve function, are suggestive of alcoholic neuropathy. The nerve tests don't identify the cause of neuropathy, only the extent of nerve damage.
  • Nerve biopsy: In rare instances, a doctor may suggest a nerve biopsy, which can show a pattern of nerve damage consistent with alcoholic neuropathy.
  • Other tests: Additional assessments might include blood tests, urine tests, or imaging studies of the brain or spinal cord to rule out other causes of neuropathy symptoms.

Conditions That May Mimic Alcoholic Neuropathy

There are a number of other medical conditions that can be confused with alcoholic neuropathy. The most common of these include:

  • Diabetic neuropathy
  • Guillain-Barre syndrome
  • Motor neuron disease, such as ALS
  • Multiple sclerosis (MS)
  • Muscle disease
  • Peripheral vascular disease
  • Spine disease

Treatment for Alcoholic Neuropathy

There are several medical treatments that can be used to manage the pain of alcoholic neuropathy. These include pain medications and antidepressants. While not specifically approved for the treatment of alcoholic neuropathy, antidepressants are often prescribed to help control the pain. Anti-seizure medications are sometimes prescribed as a way to manage pain.

Since nutritional deficiencies are partly to blame for alcoholic neuropathy, supplementation with vitamin B12, folate, vitamin E, and thiamine may be recommended.

There are no medications that can help improve loss of sensation, strengthen the muscle weakness, or aid the coordination and balance problems caused by alcoholic neuropathy. However, some people notice an improvement in symptoms a few months after discontinuing alcohol intake.

Sometimes alcohol causes such severe damage to the body that a liver transplant may be necessary. In that case, there may be some improvement in the symptoms of alcoholic neuropathy after the liver transplant, but often, the neuropathy is so advanced that there may be little, if any, improvement, even after a transplant.

Coping With Alcoholic Neuropathy

If you are diagnosed with alcoholic neuropathy and are currently taking care of yourself or you have a loved one taking care of you, you might consider getting professional help. A nurse or professional caretaker can be part of your treatment team and visit you at home regularly to help with a variety of tasks including:

  • Assessing the results of your treatments
  • Assessing your pain, sensory function, and motor function
  • Helping you adjust to using a cane, walker, or wheelchair if needed
  • Teaching you how to perform household tasks safely (e.g., wearing gloves to check the water temperature before bathing to prevent skin irritation)
  • Working with other healthcare professionals such as doctors and physical therapists to monitor your progress and make adjustments as needed

Having a nurse come to your house to suit your needs can relieve a lot of added stress on you to keep track of your treatment plan alone.

Verywell acknowledges that a private nurse or caretaker may not be feasible for everyone and that readers do not have uniform access to safe, affordable, high-quality health care.

In addition, a support group can help you cope with the life changes you're experiencing as a result of your condition. You might look for a support group specifically for alcoholic neuropathy or for people coping with chronic pain. You may also benefit from a support group to help you reduce your drinking or completely quit drinking alcohol.

Especially if you have been drinking heavily for many years, coping with alcohol use disorder is not easy. But with the proper resources to help you, you are better set up for success with sobriety.

How to Prevent Alcoholic Neuropathy

Avoiding excessive amounts of alcohol is the primary way to prevent alcoholic neuropathy. If you notice you are developing any signs of alcoholic neuropathy, in addition to seeing a doctor, avoid drinking alcohol. If you are having difficulty avoiding alcohol, there are resources that can help you quit.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. 

For more mental health resources, see our National Helpline Database.

A Word From Verywell

Alcohol use disorder is a challenging condition. The medical community has recognized that addiction is a disease and that some people are predisposed to it. As a result, it is usually necessary to get medical help to manage alcohol use disorder.

Some of the symptoms of alcoholic neuropathy can be partially reversed, but if the neuropathy becomes advanced, it might not be reversible. Medication can help in reducing some of the symptoms of alcoholic neuropathy. The most important strategy against alcoholic neuropathy lies in preventing the symptoms from getting worse by decreasing alcohol consumption as soon as possible.

7 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Chopra K, Tiwari V. Alcoholic neuropathy: Possible mechanisms and future treatment possibilitiesBr J Clin Pharmacol. 2012;73(3):348-362. doi:10.1111/j.1365-2125.2011.04111.x

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

  3. Sadowski A, Houck RC. Alcoholic neuropathy. In: StatPearls [Internet]. StatPearls Publishing.

  4. Zeng L, Alongkronrusmee D, van Rijn RM. An integrated perspective on diabetic, alcoholic, and drug-induced neuropathy, etiology, and treatment in the US. J Pain Res. 2017;10:219-228. doi:10.2147/JPR.S125987

  5. Zivković SA. Neurologic complications after liver transplantation. World J Hepatol. 2013;5(8):409-16. doi:10.4254/wjh.v5.i8.409

  6. Pullen, Richard L. Jr. EdD, MSN, RN, CMSRN, CNE-cl, Ruiz, Gerardo A. BSN, RN, CCRN. Management of alcohol-induced peripheral neuropathy. Lippincott Nursing Center.

  7. U.S. National Library of Medicine. Alcoholic neuropathy.

Additional Reading

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.