Treatment goals (assuming the immediate alcohol problem has been addressed) include controlling symptoms, maximizing ability to function independently, and preventing injury. It is important to supplement the diet with vitamins including thiamine and folic acid.
Physical therapy and/or use of orthopedic appliances such as splints may be necessary to maximize muscle function and to maintain useful positioning of the limbs.
Medication may be used if necessary to treat pain or uncomfortable sensations. Response to medications varies. The least amount of medication needed to reduce symptoms is advised, to reduce dependence and other side effects of chronic use.
Common medications may include over-the-counter analgesics such as aspirin, ibuprofen, or acetaminophen to reduce pain. Stabbing pains may respond to tricyclic antidepressants or anticonvulsant medications such as phenytoin, gabapentin, or carbamazepine.
Positioning, or the use of a bed frame that keeps the covers off the legs, may reduce pain for some people.
Treatment of autonomic dysfunction (such as blood pressure problems, difficulty with urination, and slow gastrointestinal movement) may be necessary. Treatment may be chronic and long term, and response to treatment varies.
Many treatments may be tried before finding one that is successful in reducing symptoms. Wearing elastic stockings, eating extra salt, sleeping with the head elevated, or using medications such as fludrocortisone may reduce postural blood pressure changes (orthostatic hypotension).
Manual expression of urine, intermittent catheterization, or medications such as bethanechol may be necessary to treat bladder dysfunction.
Impotence, diarrhea, constipation, or other symptoms are treated when necessary. These symptoms may respond poorly to treatment.
It is important to protect arms and legs with reduced sensation from being injured. This may include checking the temperature of bath water to prevent burns, change in footwear, frequent inspection of shoes to reduce injury caused by pressure or objects in the shoes, or other measures. Extremities should be guarded to prevent injury from pressure.
Use of alcohol should be stopped to reduce progression of the damage. Treatment of alcoholism may include psychiatric interventions, social support such as AA (Alcoholics Anonymous), medications, and behavior modification.
