eMedicine Specialties > Physical Medicine and Rehabilitation > Peripheral Neuropathy
Alcoholic Neuropathy: Treatment & Medication
Updated: Sep 5, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Rehabilitation Program
Physical Therapy
Comprehensive physical therapy for patients with alcoholic neuropathy may include the following:
- Gait and balance training, possibly with an assistive device for safety
- Range of motion (ROM) exercises and stretching, particularly for the gastrocnemius-soleus muscle, to prevent contracture and maintain normal gait mechanics
- Strength training of weakened muscles
Occupational Therapy
Occupational therapy also can be an important component of the rehabilitation process in individuals with alcoholic neuropathy. Various elements can be combined into a program to help the patient maximize function, including the following:
- Training in performance of activities of daily living (ADL), with adaptive equipment if necessary
- Compensatory strategies to accommodate for insensate or weakened limbs
Medical Issues/Complications
Home evaluations can be ordered to assess the safety, appropriateness, and functionality of the patient in the home.
Surgical Intervention
If liver damage is evident, appropriate consultation with a transplantation service is recommended. However, neuropathy is generally an exclusion criterion for transplantation.
Interestingly, there has been a case of liver transplantation resulting in resolution of alcoholic polyneuropathy, although the patient was also treated for nutritional and vitamin-deficiency polyneuropathy.15
Related Medscape topic:
Resource Center Liver and Intestine Transplant
Consultations
- Consultation with a psychiatrist may be indicated to help patients with chronic alcoholism recover from the physical and emotional withdrawal associated with cessation of alcohol consumption.
- Consultation with a nutritionist may be indicated to help formulate strategies for replacement of essential nutrients in malnourished alcoholic patients.
- Referral to a substance abuse support group, such as Alcoholics Anonymous (AA), may help patients to cope with alcohol cessation.
Other Treatment
An ankle-foot orthosis (AFO) may be needed to assist patients with weak ankle dorsiflexion, eversion, and/or plantar flexion. This device also can help with ankle proprioception and can improve gait and prevent ankle sprains. Vigilant foot care and the use of shoes with an enlarged toe box are useful in preventing foot ulcers.
The use of warm or hot footbaths is a potential hazard in alcoholic neuropathy, because such treatment may cause burns to a patient with an insensate extremity.
Medication
Painful dysesthesias associated with alcoholic neuropathy can be treated using gabapentin or amitriptyline as adjunct agents with other OTC pain medications, such as aspirin or acetaminophen.
Anticonvulsants
Use of certain antiepileptic drugs, such as the gamma aminobutyric acid (GABA) analogue Neurontin (gabapentin), has proven helpful in some cases of neuropathic pain. These drugs have central and peripheral anticholinergic effects, as well as sedative effects, and they block the active reuptake of norepinephrine and serotonin. The multifactorial mechanism of analgesia could include improved sleep, an altered perception of pain, and an increase in the pain threshold. Rarely should these drugs be used in the treatment of acute pain, because a few weeks may be required for them to become effective.
Gabapentin (Neurontin)
Has anticonvulsant properties and antineuralgic effects; however, the exact mechanism of action is unknown. Gabapentin is structurally related to GABA but does not interact with GABA receptors.
Adult
300 mg PO tid; may increase up to 1200 mg PO tid; titration to effect can take place over several days (300 mg on day 1, 300 mg bid on day 2, and 300 mg tid on day 3)
Pediatric
Not recommended
Antacids may significantly reduce bioavailability (administer at least 2 h following antacids); may significantly increase norethindrone levels
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in severe renal disease
Tricyclic antidepressants
These agents make up a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. They have central effects on pain transmission and block the active reuptake of norepinephrine and serotonin.
Amitriptyline (Elavil)
Analgesic for certain chronic and neuropathic pain.
Adult
10-25 mg PO qhs initially; titrate to 25 mg tid if necessary
Pediatric
<12 years: Not recommended
>12 years: Administer as in adults
Phenobarbital may decrease effects; coadministration with CYP2D6 enzyme system inhibitors (eg, cimetidine, quinidine) may increase levels; inhibits hypotensive effects of guanethidine; may interact with thyroid medications, alcohol, CNS depressants, barbiturates, and disulfiram
Documented hypersensitivity; patient has taken MAOIs in past 14 d; patient has history of seizures, cardiac arrhythmias, glaucoma, and urinary retention
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in cardiac conduction disturbances and history of hyperthyroidism, and renal or hepatic impairment; avoid using in elderly patients
Analgesic, Topical
When used topically, capsaicin works through the depletion of substance P. It causes significant burning sensations when applied, and patients must be educated about this effect.
Capsaicin (Dolorac, Zostrix)
Natural chemical derived from plants of the Solanaceae family. Penetrates deep for temporary relief of minor aches and pains of muscles and joints associated inflammatory reactions. May render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons.
Adult
Apply to affected area tid/qid for 3-4 consecutive wk and evaluate efficacy; not to exceed 4 applications/d; wash hands with soap and water after applying
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; broken or irritated skin
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
For external use only; avoid contact with eyes; do not use tight bandage; discontinue use if condition worsens or symptoms persist for 14-28 d
More on Alcoholic Neuropathy |
| Overview: Alcoholic Neuropathy |
| Differential Diagnoses & Workup: Alcoholic Neuropathy |
 Treatment & Medication: Alcoholic Neuropathy |
| Follow-up: Alcoholic Neuropathy |
| References |
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References
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Further Reading
Keywords
alcoholic neuropathy, alcohol neuropathy, peripheral neuropathy, alcoholism-induced neuropathy, alcohol-related neuropathy, primary axonal sensorimotor peripheral polyneuropathy, neuropathy treatment, axonal neuropathy, neuropathy pain, symptoms of neuropathy, nutritional axonal sensorimotor polyneuropathy, nutritional neuropathy, toxic axonal sensorimotor polyneuropathy, alcoholism, alcohol addiction
