Do You Need Medication for Restless Leg Syndrome?

Restless leg syndrome, also known as RLS is a condition that causes the sufferer to experience acute discomfort in the leg that can be alleviated by movement. This is often characterised by a rapid and repetitive “bobbing” of the leg, though the sensation can also be improved by walking or other physical activity. As well as the leg however (and despite the name), RLS can affect any body part with the arms being the second most common. The discomfort experienced by RLS patience is unlike any other and can be hard for the patient to describe, though there is usually no pain associated with the condition. Restless leg syndrome is not fully understood and medication for restless leg syndrome is controversial.

RLS is also characterised as getting worse at night and often being more severe in older patients which also helps with diagnosis. Interestingly RLS can also be classed in one of two ways, as either ‘primary’ or ‘secondary’. Primary RLS is any incidence of restless leg syndrome that is either genetic or that develops on its own, while secondary cases describe those that occur as a result of the patient taking other medication with RLS being a common side effect of many pharmaceuticals. It is important therefore that RLS be identified as primary and that all other pharmaceutical causes be ruled out before medication for restless leg syndrome is advised.

RLS is likely a psychosomatic condition, suggesting that it is caused by an interplay of both physical and psychological elements. It is speculated that RLS might hold evolutionary advantages as a system to encourage activity and discourage our ancestors from spending too long in one place, in this sense the feeling could be akin to the feeling of being ‘antsy’ or ‘fidgety’ that we all experience to some degree. However evidence including animal studies, and brain imaging studies suggests that RLS sufferers may also have imbalances of dopamine, iron and magnesium, which is what medication for Restless leg syndrome addresses. Such medication is generally successful in treating the condition suggesting that there is indeed a connection between the two. Furthermore, iron related markers are found in the spinal fluid of sufferers, and the most commonly associated medical condition is iron deficiency.

Dopamine treatments, as with any medication for psychological conditions, are guilty of assuming causality – that the restless leg syndrome is caused by these chemical imbalances rather than it being the other way round, or them both being caused by a third unknown factor. A cognitive approach might describe restless leg syndrome as coming from certain thought patterns as a form of expression or catharsis almost. Some patients describe the feeling as coming from general anxiety, stress or impatience and that their fidgeting is an indication that they want to ‘get going’. Others describe the restless movement as a way of ‘staying awake’ when tired which fits with the description of RLS as worsening later in the day.

Meanwhile some incidences of RLS are even conscious and are used by anorexics for example as a way to burn calories while sitting still. Such behaviours may then become habitual and unconscious. For this reason treating the condition immediately with drugs rather than addressing potential psychological causes can be rash. Sufferers can treat themselves for the psychological associations too, by noticing when the fidgeting begins and forcing themselves to relax and control breathing. Stretching can also be a useful way to alleviate the irritation and can immediately suppress the sensation. Patients are encouraged then to stand up and stretch when they feel the urge to move, touching their toes and feeling the stretch in their calves, quads and hamstrings. Similarly, a musculoskeletal approach has been developed that claims to be successful in 80-90% of cases. This involves gentle massage of the lower lumbar spine which aims to prevent somatic dysfunction which appears to be present in many cases of RLS and is characterised by increased (rather than decreased) spinal activity during sleep.

Such methods are particularly encouraged as medication for restless leg syndrome is not curative and is associated with many side effects including nausea, orthostatic hypotension, hallucinations and sudden sleep attacks. Furthermore it can be expensive and more so as it is indefinite. One commonly used type of medication for restless leg syndrome are dopamine agonists such as ropinirole, pramipexole and carbidopa, however these can potentially cause augmentation causing the symptoms to actually worsen, or ‘rebound’ causing them to come back stronger. Dopamine also affects the personality and use of such drugs has been shown to increase compulsive gambling. Another popular form of medication are opioids such as propoxyphene and methodone. Worryingly these drugs use the same mechanism of operation as other opioids including morphine and opium and are highly addictive. For these reasons, medication for restless leg syndrome is a rather extreme response to the symptoms, making massage, stretching and self help far more prudent.

However the fact that secondary restless RLS can be caused by taking other medication does suggest that there may in some cases be a chemically caused condition. It is also interesting to note however that 60% of cases of RLS are familial which seems to suggest a genetic element to the disorder. Supplementing the diet with iron and magnesium is a healthy, natural option that may help lessen the symptoms. Similarly patients should avoid stimulants such as excess amounts of caffeine or Guarana which can cause restlessness and fidgeting on their own. Also potentially effective are muscle relaxants such as GABA or sleeping aids.

As a general rule however, the symptoms of RLS are mild and bearable, while it might cause mild discomfort and irritation (as well as irritation to those in close proximity) or difficulty sleeping in some cases, this certainly does not necessitate the use of strong drugs with undesirable side effects. Self help methods, stretching, massage and supplementation are generally preferable to medication for restless leg syndrome.

1 comment

  1. Pen Reply
    October 15, 2013 at 1:51 am

    "RLS is likely a psychosomatic condition". Based on that you ridicule a complete group of patients? Find PROOF first, then publish.

    Especially if it IS psychosomatic, you need to consider the patients!!! And you do not cure them by saying they're not really sick. For most people, if a disease isn't visible, it doesn't exist. That puts a heavy strain on sufferers (of any invisible disease) and you are just adding to that!

    So again, make sure before you hurt your patient with this kind of psychobabble.

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