Does it matter? All's fair in love and war. This is war. RLS by day is annoying but intolerable at night. I would venture a guess that about 40% to 50% of the people on here would benefit and maybe completely rid themselves of RLS by switching out or dropping prescription meds such as Prozac, Tagamet, HRT, Statins etc. The list of bad for RLS medicines is becoming longer with each passing week it seems.
And about another 45% of the people on here are battling other conditions that lead to RLS. Just about any spinal/back injury that affects the nerves/CNS will lead to RLS. Even varicose veins (venous insufficiency) which press on nerves in the legs can be a culprit. Infections, bacterial or viral can lead to RLS. I believe this is because when our body is under attack it withholds the absorption and release of iron in an effort to starve out the critters. In the process our brains are denied iron. No iron to the brain means no release of dopamine which means RLS. Diabetes, obesity, kidney failure, MS all seem to be linked to RLS in those that are genetically predisposed. Diabetes is at epidemic proportions so is the use of statins, but there is not a corresponding epidemic of RLS so its just us special few that will have it triggered by these things. Finally, there's one or two percent of people on here that are not on any medications or supplements, have no disease or back problems or infections or obesity, and still have RLS.
We know that RLS brains are anemic and that we have plenty of dopamine kicking around up there, but our dopamine receptors are bad and getting worse with age. Those receptors are the gateway by which dopamine travels through-out our central and peripheral nervous system and quiet our legs and bodies. So the dopamine agonists, which temporarily shore up those receptors work!!! And as you know, substances like cocaine, amphetamines, cause a rush of dopamine everywhere in our bodies. I don't think these substances shore up the receptors exactly but somehow they cause a release of dopamine. I believe the same is true for the opiates...not agonists but are analgesics and facilitators of dopamine. So they too relieve RLS.
We really understand a lot about RLS but what we need are some leaders in the field to come up with benign substances that cause the release of dopamine but aren't so stimulating or addictive that they keep us awake and defeat the whole purpose. In experiments (not necessarily regarding RLS) researchers will use large amounts of potassium to simulate our brains on meth and then try to find substances that will stop the cascade of events that happen when there's an overdose. In other words, the researchers are looking for a substance that can be administered in the ER when someone is brought in with an over dose. But what does that experiment, which is unrelated to RLS tell us? It tells us that potassium triggers the release of dopamine and that's what we're looking for. Standing, walking, listening to music, orgasm, all cause the release of dopamine. But we can't do those things all night long and get some sleep.
I too am not a fan of the opiates or the agonists but until I find a reasonable alternative
or until you find one (Pleeeeeeeeeeeze find one) what choice do these people have? Why can't we put dopamine (L-Dopa) into some type of spinal pump thus bypassing the brain and bringing dopamine right to the CNS? Just a strange thought I've been having lately. There may be numerous reasons why that can't be done.