Alcoholic Neuropathy Treatment & Management

  • Author: Scott R Laker, MD; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Dec 5, 2011
 

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
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Medical Issues/Complications

Home evaluations can be ordered to assess the safety, appropriateness, and functionality of the patient in the home.

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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.[17]

Related Medscape topic:

Resource Center Liver and Intestine Transplant

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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.
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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.

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Contributor Information and Disclosures
Author

Scott R Laker, MD  Staff Physician, Department of Rehabilitation, University of Colorado Health Sciences Center

Scott R Laker, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

William J Sullivan, MD  Associate Professor, Pain Medicine Fellowship Site Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center

William J Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel D Scott, MD, MA  Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Attending Physician, Department of Physical Medicine and Rehabilitation, Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System

Daniel D Scott, MD, MA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier III, MD  Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

References

  1. Alvarez P, Ferrari LF, Levine JD. Muscle pain in models of chemotherapy-induced and alcohol-induced peripheral neuropathy. Ann Neurol. Jul 2011;70(1):101-9. [Medline]. [Full Text].

  2. Yerdelen D, Koc F, Uysal H. Strength-duration properties of sensory and motor axons in alcoholic polyneuropathy. Neurol Res. May 16 2008;[Medline].

  3. Corsetti G, Rezzani R, Rodella L, et al. Ultrastructural study of the alterations in spinal ganglion cells of rats chronically fed on ethanol. Ultrastruct Pathol. Jul-Aug 1998;22(4):309-19. [Medline].

  4. Narita M, Miyoshi K, Narita M, et al. Involvement of microglia in the ethanol-induced neuropathic pain-like state in the rat. Neurosci Lett. Feb 27 2007;414(1):21-5. [Medline].

  5. Chen X, Levine JD. Mechanically-evoked C-fiber activity in painful alcohol and AIDS therapy neuropathy in the rat. Mol Pain. 2007;3:5. [Medline]. [Full Text].

  6. Miyoshi K, Narita M, Takatsu M, et al. mGlu5 receptor and protein kinase C implicated in the development and induction of neuropathic pain following chronic ethanol consumption. Eur J Pharmacol. May 21 2007;562(3):208-11. [Medline].

  7. Koike H, Iijima M, Sugiura M, et al. Alcoholic neuropathy is clinicopathologically distinct from thiamine-deficiency neuropathy. Ann Neurol. Jul 2003;54(1):19-29. [Medline].

  8. Koike H, Mori K, Misu K, et al. Painful alcoholic polyneuropathy with predominant small-fiber loss and normal thiamine status. Neurology. Jun 26 2001;56(12):1727-32. [Medline].

  9. Masaki T, Mochizuki H, Matsushita S, et al. Association of aldehyde dehydrogenase-2 polymorphism with alcoholic polyneuropathy in humans. Neurosci Lett. Jun 17 2004;363(3):288-90. [Medline].

  10. Avaria Mde L, Mills JL, Kleinsteuber K, et al. Peripheral nerve conduction abnormalities in children exposed to alcohol in utero. J Pediatr. Mar 2004;144(3):338-43. [Medline].

  11. Pessione F, Gerchstein JL, Rueff B. Parental history of alcoholism: a risk factor for alcohol-related peripheral neuropathies. Alcohol Alcohol. Nov 1995;30(6):749-54. [Medline].

  12. Ammendola A, Gemini D, Iannaccone S, et al. Gender and peripheral neuropathy in chronic alcoholism: a clinical-electroneurographic study. Alcohol Alcohol. Jul-Aug 2000;35(4):368-71. [Medline]. [Full Text].

  13. Chopra K, Tiwari V. Alcoholic Neuropathy: Possible Mechanisms and Future Treatment Possibilities. Br J Clin Pharmacol. Oct 11 2011;[Medline].

  14. Peters TJ, Kotowicz J, Nyka W, et al. Treatment of alcoholic polyneuropathy with vitamin B complex: a randomised controlled trial. Alcohol Alcohol. Nov-Dec 2006;41(6):636-42. [Medline]. [Full Text].

  15. Fama R, Eisen JC, Rosenbloom MJ, et al. Upper and lower limb motor impairments in alcoholism, HIV infection, and their comorbidity. Alcohol Clin Exp Res. Jun 2007;31(6):1038-44. [Medline].

  16. Schott K, Schäfer G, Günthner A, et al. T-wave response: a sensitive test for latent alcoholic polyneuropathy. Addict Biol. Jul 2002;7(3):315-9. [Medline].

  17. Gane E, Bergman R, Hutchinson D. Resolution of alcoholic neuropathy following liver transplantation. Liver Transpl. Dec 2004;10(12):1545-8. [Medline]. [Full Text].

  18. Dell PC, Guzewicz RM. Atypical peripheral neuropathies. Hand Clin. May 1992;8(2):275-83. [Medline].

  19. Agelink MW, Malessa R, Weisser U, et al. Alcoholism, peripheral neuropathy (PNP) and cardiovascular autonomic neuropathy (CAN). J Neurol Sci. Dec 11 1998;161(2):135-42. [Medline].

  20. Bushbacher L. Rehabilitation of patients with peripheral neuropathies. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: Saunders; 1995:984.

  21. Hilz MJ, Zimmermann P, Rösl G, et al. Vibrameter testing facilitates the diagnosis of uremic and alcoholic polyneuropathy. Acta Neurol Scand. Dec 1995;92(6):486-90. [Medline].

  22. Koike H, Sobue G. Alcoholic neuropathy. Curr Opin Neurol. Oct 2006;19(5):481-6. [Medline].

  23. Monforte R, Estruch R, Valls-Sole J, et al. Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related toxic effect of alcohol. Arch Neurol. Jan 1995;52(1):45-51. [Medline].

  24. Nishiyama K, Sakuta M. Mexiletine for painful alcoholic neuropathy. Internal Medicine. 1995, June;34(6):577-9. [Medline]. [Full Text].

  25. Oishi M, Mochizuki Y, Suzuki Y, et al. Current perception threshold and sympathetic skin response in diabetic and alcoholic polyneuropathies. Intern Med. Oct 2002;41(10):819-22. [Medline]. [Full Text].

  26. Scholz E, Diener HC, Dichgans J, et al. Incidence of peripheral neuropathy and cerebellar ataxia in chronic alcoholics. J Neurol. Aug 1986;233(4):212-7. [Medline].

 
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