The World of Chronic Pain
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The World of
Chronic Pain

More than 125 million Amercians are suffering.

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These conditions can cause a world of pain.

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Be sure you know the cautions and side effects.

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Finding help is not always simple for those in pain.

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These tips can help prevent a lifetime of pain.

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Up-to-date news on pain-related issues.

Restless Leg Syndrome

It's estimated that 15 to 20 percent of the population, mostly middle-aged women, suffer from Restless Legs Syndrome, It's a very common, albeit seldom discussed problem. As the quote from the Restless Legs Syndrome Organization states, restless legs syndrome is "the most common disorder you've never heard of."

It feels like bugs are crawling on your legs, especially on the calves. Your legs tickle. They itch. You move them, trying to alleviate the sensation. You have the urge to keep moving your legs as you seek relief. Unfortunately, all the restlessness doesn't help sleep disorders.

The Restless Less Syndrome Foundation describes RLS as an overwhelming urge to move the legs usually caused by uncomfortable or unpleasant sensations in the legs. The sensations have the following features:
  • Occur during periods of inactivity
  • Become more severe in the evening and at night
  • Are relieved by movement of the limb
  • Often cause difficulty staying or falling asleep, which lead to feelings of daytime tiredness or fatigue
  • May cause involuntarily jerking of the limbs during sleep and sometimes during wakefulness
There is no known cure for RSL. It generally hits women in their 50's and 60's but may have started in childhood as "growing pains."

If an underlying iron or vitamin deficiency is found to be the cause of your restless legs, supplementing with iron, vitamin B12 , or folate (as indicated) may be sufficient to relieve your symptoms. Because the use of even moderate amounts of some minerals (such as iron, magnesium, potassium, and calcium) can impair your body’s ability to use other minerals or can cause toxicity, you should use mineral supplements only on the advice of your health-care provider. Current recommendations include checking a serum ferritin level (to evaluate iron-storage status) and supplementing with iron if your ferritin level is less than 50 mcg/L.

The use of some medications seems to worsen the symptoms of RLS. These drugs include calcium-channel blockers (used to treat high blood pressure and heart conditions), most antinausea medications, some cold and allergy medications, major tranquilizers, phenytoin, and most medications used to treat depression.

A healthy balanced diet is important in reducing the severity of RLS. Caffeine may seem to relieve symptoms but is most likely to delay and then intensify the symptoms later in the day. Doctors recommend avoiding all caffeine including chocolate, tea, and soft drinks. Alcohol also intensifies the symptoms for most individuals.

You may find that you achieve your best sleep later in the 24-hour cycle—for example, sleeping from 2 AM until 10 AM may work best for you. Some people find that performing isometric exercises for a few minutes before bed is helpful.

Walking, stretching, taking a hot or cold bath, massaging your affected limb, applying hot or cold packs, using vibration, performing acupressure, and practicing relaxation techniques (such as biofeedback, meditation, or yoga) may help reduce or relieve symptoms. Keeping busy during times you must remain seated, such as airplaine flights, may also alleviate the symptoms.

Most people with RLS eventually turn to medications. The first-line treatment for RLS is with dopaminergic agents: primarily dopamine-receptor agonists like Mirapex (pramipexole), Permax (pergolide), and Requip (ropinirole), but also drugs like Sinemet (carbidopa/levodopa) that add dopamine to the system. Although dopaminergic agents are used to treat Parkinson’s disease, RLS is not a form of Parkinson’s disease. All of these drugs should be started at low doses and increased very slowly to decrease potential side effects.

Of the dopaminergic agents, Sinemet has been used the longest, but it has recently been found to cause a serious problem, known as augmentation, in the vast majority of patients who take it for the treatment of RLS. If you are taking Sinemet, you need to be aware of this problem and should discuss it with your physician. Also, you should not take Sinemet within two hours after eating a high-protein meal.

Pain-relieving drugs are used most often for people with severe relentless symptoms of RLS. Some examples of medications in this category include codeine, Darvon or Darvocet (propoxyphene), Dolophine (methadone), Percocet (oxycodone), Ultram (tramadol), and Vicodin (hydrocodone).

Anticonvulsants are particularly effective for some, but not all, patients with marked daytime symptoms, particularly people who have pain syndromes associated with their RLS. Gabapentin (Neurontin) is the anticonvulsant that has shown the most promise in treating the symptoms of RLS.

Sedatives are most effective for relieving the nighttime symptoms of RLS. They are used either at bedtime in addition to a dopaminergic agent or for individuals who have primarily nighttime symptoms. The most commonly used sedative is clonazepam (Klonopin).

Work closely with your healthcare provider in devising a system that works best for you. Keep up with the latest news.