Exercise Routine

[John_naylor]

My RLS has been kept to a tolerable level with Tramadol and if I avoid triggers can sleep thro' most nights. I decided that I would like to become a bit fitter but was aware that this could make RLS worse. I signed up for a 45 mile charity cycle ride and have been trying to go out training 2 or 3 times a week but my RLS is quite bad at the moment (arms and legs, up 3 or 4 times every night) preventing me from achieving a training routine. Any advice/ experiences? Do I give in or just "man up" and do it?

[Madlegs1]

John- sorry to hear your troubles.

I'm on oxycontin ( similar to Tramadol) and generally am free from rls except for stupid trigger malfunctions.

I don't have much reaction to exercise but would try building up gently and slowly. I do short Adventure races - 30km cycling plus shuffling and kayak. I'm 70 yrs young.

Hydration is extremely important.

All the very best in your efforts.

Might be worth taking some vit C as well.??

[DicCarlson]

This is how mine started - almost a year ago. Training for a 40 mile bicycle race. I developed horrible leg cramps every night then RLS, then both. No Sleep at all. The day before the race I did a training ride and crushed it. I went home cooked and ate some pasta, went to bed. I slept an hour and a half then up all night walking around. I didn't do the race. Coming back from that I would do very short, low intensity bike rides. Iron supplements eliminated the RLS but I'm still plagued with insomnia. Yes to hydration and sea salt in water.

[Hidden in reply to DicCarlson]

Well Dic, I think you know me, and I hate to make this recommendation, but I think you need a little relief from insomnia. I was prescribed this drug for IBS but found that it induced sleep and then I read in small doses it does induce sleep. It's called Remeron/Mirtazapine and several people on here use it for depression. I have 15mg tablets (I think they're 15) and I cut them in four and let one quarter dissolve under my tongue at night. For a long time I did this every night for the IBS and then I ran out and didn't refill for a month. No withdrawal symptoms that I was aware of. However one or two nights after a couple of weeks I remember awakening and feeling a twinge of anxiety. I found it interesting, not scary. And fell back to sleep. I feel confident that it was my brain returning to homeostasis after years of the 4mg of remeron.

It's quite affordable especially if insurance will pay a portion and my doctor has no qualms about refilling this prescription. It is not a controlled substance in the US and has a good safety profile.

[DicCarlson in reply to Hidden]

Thanks for that advice. My insomnia is not debilitating at this point. I sleep, but have numerous awakenings. Leaning more toward the inflammation theory of RLS - even without higher Homocysteine or CRP. Started a jag of anti-inflammation supplements.

[Hidden]

Hi John, I think I might know why taking the bisglycinate at the same time as tramadol might negate the immediate effect that people who are not taking tramadol realize. Tramadol as described in the article below will raise serotonin and norepinephrine and thus has antidepressant properties. Because tramadol raises both of these chemicals it seems to be more like Wellbutrin which tends not to bother people's RLS and then in addition it works on the opioid receptors to provide pain relief. Gapapentin also raises serotonin levels along with raising Gaba levels. I think both of these drugs, like antidepressants, will negate the immediate effect that iron provides if you take the two at the same time.

I assume if you met force with force and took enough iron then you might see immediate effect from the bisglycinate but that's probably not wise. I also read that Tramadol has about a six hour half life. I recalled tonight that Bganim1947 takes tramadol and gabapentin (not for RLS) but I would bet that she takes these things in the morning and therefore the bisglycinate provides her with immediate relief at night. The Gabapentin also has a half life of about six hours I believe.

On the bright side, even if you can't take the tramadol about 90 minutes after the iron, you will still be raising your iron levels in the long run and this may prove effective too in combating your symptoms of RLS.

Tramadol has several mechanisms of action:

Action on mu-opioid receptors:

Clinical studies on tramadol suggest that the active drug molecules also exert their action by decreasing the transmission of nerve signal carrying pain sensation. This effect is achieved by direct action of tramadol on mu-opioid receptors (receptors that accept information about moderate to severe intensity pain). However, unlike most narcotic agents, the tramadol effect is very mild (1/10 of that of morphine). This is responsible for its low addiction risk. According to MC Frank, the primary action of tramadol is mediated by increasing the dopamine turnover on mu-opioid receptors.

Norepinephrine uptake inhibition theory:

B. Driessen suggests that since the action of tramadol on mu-opioid receptors is very little, other mechanisms of action may be responsible for its potent analgesic effect. He carried out a series of experiments on rat brain models and identified that the active metabolic of tramadol is O-desmethyltramadol. This is responsible for primary actions of the parent drug by inhibiting the uptake of norepinephrine.

R. B. Raffa presented his research model on rat brains after subjecting it to tramadol exposure. He identified that the active chemicals of tramadol have modest affinity (attraction) for mu-opioid receptors but the analgesic (pain-relieving effect) is incomplete without neurochemicals like epinephrine and serotonin. R.B. Raffa identified that tramadol blocks the uptake of norepinephrine and serotonin to exert its analgesic actions. Alteration in serotonin levels is responsible for the pleasure and mood elevation effects noticed with tramadol. This can also be explained by the reversal of depression (that is caused by low serotonin levels in brain) upon tramadol intake, or the development of depressive symptoms upon its withdrawal.

Bottom Line

The partial effect of tramadol on mu-receptors is responsible for weak but significant addiction potential with prolonged use. The inhibition of norepinephrine uptake and serotonin is responsible for the potent side effects observed with MAO inhibitors (a class of drug) and other serotonin-elevating medications.

[John_naylor]

Wow! Thanks for that comprehensive response, will need to take that in. I am trying to adjust the times of taking Tramadol, instead of 100mg at 8pm, 50mg early to calm the evening and 59mg later. If desperate I take another 50mg during the night. I have been taking bisglycinate at 11pm so it is separated from Tramadol. Will experiment with timings some more. Thanks so much for your advice.

[Rescuemom]

I had read tramadol was a trigger for rls, i have some left over from knee surgery. I am desperate to stop the all day rls and the accompanied insomnia. What is working for yiu?

[John_naylor in reply to Rescuemom]

Tramadol is considered a very useful drug for reducing RLS rather than being an RLS trigger for most people. It has been my saviour now for probably over 5 years as dopamine agonists failed (augmentation) and Gabapentin and Pregablin were insufficient on their own. I supplement 100mg Tramadol with 1.2gm Gabapentin currently and survive on that. Sometimes I get a night’s sleep with some evening episodes in my hands and legs, but often I am up 3 or 4 times a night as well. It’s getting worse year by year and I’m not sure where I will go to next...

Before you experiment with Tramadol you really need to relate your full experiences with RLS and list any other drugs you take. Your ferritin level needs measuring (the number not just a GP’s “normal”. Post it all on this site and you will get some amazing support and help. You will need to read up and become your own expert as most GP’s have little experience. RLS by Henning etc is worth reading.

Good luck

John