Summary: Clinicians should consider the diagnosis of alcoholic polyneuropathy in patients who presently use alcohol excessively and patients who, while currently sober, have a history of such behavior.
In 2015, according to The National Institutes of Health (NIH), there were approximately 15 million alcoholics in the US–with estimates suggesting that up to 10 million of them suffered from the most common neurological complication associated with alcoholism, painful small fiber peripheral neuropathy. As previously discussed, the toxic effects of alcohol on intestinal thiamine (vitamin B1) transporter molecules act to inhibit the absorption of dietary/water soluble thiamine. This leads to thiamine deficiency and contributes to alcoholic peripheral neuropathy.
The duration and quantity of alcohol consumption over the course of a patient’s lifetime are the factors most directly associated with the development of alcoholic peripheral neuropathy. Clinicians should take a detailed history of their patient’s alcoholic consumption–keeping in mind that many patients tend to underreport their use of alcohol. Patients with painful polyneuropathy who currently drink alcohol to excess and reformed alcoholics–no matter how long the length of sobriety–should be considered for treatment with thiamine supplementation if the patient’s lifetime consumption of alcohol warrants it.
Clinically, supplementation with benfotiamine, a lipid soluble form of thiamine, has been shown to safely and rapidly reverse thiamine deficiency in alcoholics and is an excellent treatment choice for these patients.*