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Providing straightforward information pertaining to drugs, drug use & drug policy. The Grey Pages promotes drug-related literacy and advocates a system of viable and tolerant drug policies. This is my personal collection of commentaries, essays, tid-bits, and other such writings on everything ranging from drug use, drug policy and drug-myths, to drug-science, addiction, human behavior, and the workings of the human brain. I started this blog with a particular focus on opioids, and over the past year have found my interest gravitate toward the intriguing, ever-changing world of designer intoxicants (i.e. "research chemicals" or "designer drugs").

Thursday, March 17, 2011

Treating RLS

Restless Legs Syndrome
RLS, is also known as Wittmaack–Ekbom syndrome. It is a medically recognized condition characterized by the irresistable urge to move or stretch one's limbs due to odd, sometimes extremely uncomfortable sensations. The sensations are often difficult for patients to describe in words, but are often described as aching, electrical, buzzing, tickling, or antsy sensations felt in the legs or arms. The intensity of the symptoms can range from mild to severe; severe cases may cause a significant impact on their everyday activities, with subsequent sleep loss, drowsiness and fatique, which can be increasingly detrimental to aspects of one's life.
Symptoms of RLS most frequently manifest in the legs, but may also occur in the arms and even phantom limbs. In severe cases, all limbs of the body may be affected, which is typically described as severely uncomfortable.

The underlying cause of RLS is unknown, but most research focuses on the dopamine system and iron levels. This is based on documentation of some succesful treatment of symptoms with iron supplements and levodopa; a centrally acting prodrug for dopamine. Samples of cerebrospinal fluid in RLS subjects have also shown some irregularities in dopamine and iron within the CSF fluid. Symptoms of RLS most often occur at night time/bed time, during which time dopamine levels are at their lowest. Irregularities in the endogenous opioid system may play a role in the condition as well; studies have suggested a possible opioid role in some cases.

One of the first steps in identifying/treating RLS should be bloodwork in order to rule out/check for iron or folic acid deficiencies; approx. 20 percect of RLS subjects may have low iron levels as a contributing factor.
RLS in some cases may be secondary to an underlying condition, these include but are not limited to; magnesium deficiency iron deficiency, diabetes, thyroid disease, peripheral neuropathy, arthritis, and fibromyalgia. Additionally, moderate to severe symptoms of RLS are often present in opioid users during and sometimes after acute withdrawal syndrome.

Certain drugs and medications have been known to also cause or worsen RLS symptoms; these include monoaminergic antidepressants (MAO, SRI, Tricyclics) and antihistamines (diphenhydramine, dimenhydrinate).

Treating RLS Symptoms

Over the counter supplements: Iron, magnesium, melatonin, potassium, folic acid, calcium, vitamin E, st johns wort or simply multivitamins may help in the case of an underlying mineral deficiency,

Over the counter analgesics - acetaminophen, ibuprofen, aspirin, naproxen.

Dopamine agonists may be effective in some individuals: ropinirole, pramipexole, pergolide, rotigotine, carbidopa, levodopa.

Benzodiazapines and Nonbenzodiazepines: diazepam, clonazepam, zolpidem, zopiclone, eszopiclone; these not only help with the physiological symptoms, but help promote sleep and reduce night awakenings.
Anticonvulsants: gabapentin, carbemazepine, these may help especially in those with painful RLS symptoms.

Opioids: Have been highly effective for severe or resistant cases, as well as RLS symptoms related to neuropathic pain conditions; morphine, buprenorphine, hydrocodone, oxycodone, fentanyl. Opioids with NMDA antagonist activity may be especially effective - tramadol, methadone, levorphanol. For those unable to obtain opioids by prescription, a peripherally acting opioid such loperamide (Immodium AD) is available over the counter and can be taken in high doses (> 20mg) to treat RLS.

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