Has anyone experienced a link between RLS getting worse by the regular use of painkillers for other problems?
RLS started recently during lockdown and getting worse, even sometimes when I sit or watch TV. It seems to be worse after days when I take painkillers for managing back pain. The connection with Codeine seemed obvious so I switched to Tramadol, which helped for a while but now I seem to get RLS whether I take the painkiller or not.
I’m 60 and run/cycle regularly. Struggling to maintain a healthy sleep routine although I will eventually get to sleep if I get up, walk, stretch and have something to eat or drink, then try again.
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Mandev
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The painkillers you mention are known to relieve RLS rather than make it worse so it's unlikely that these medications are making your RLS worsen.
It is possible that one of the "excipients" used in the painkillers might be an issue. Excipients are the non-active contents of the tablets/capsules. The most commonly used one is lactose. If you are lactose intolerant this may be a factor in your RLS.
The problem that can happen with tramadol is it can cause "rebound". This is where altlhough it can suppress RLS when you take it, after it wears off the symptoms can "bounce back".
Some medications commonly used for chronic pain such as SSRI or tricyclic antidepressants (e.g. amitriptyline) are known to make RLS worse and should be avoided.
Gabapentin or pregabalin often used for chronic pain/back pain however are also recommended for RLS even if you have no pain.
I'd therefore suggest that if you do have chronic back pain and you want to take a regular medication for this, then try gabapentin or pregabalin.
One of these might replace the opiates.
It would be a good idea to also investigate the other non-pharmacological measures that should be considered for somebody with RLS i.e. in relation to iron deficiency and aggravating factors.
Thank you for your helpful reply Manerva. Lots of information which I will work through. I had not considered the bounce-back effects for this condition although I am well versed in this subject in relation to migraines. The associated link I’m observing between pain killers and my RLS escalation certainly falls into that category and I this will be my starting point. Then you’ve given me loads to research and try. What my doctors said this morning is that RLS needed a clinical diagnosis and all they could do was suggest I research Ropinirole and Pramipexole and decide if I wanted to try either. I am a MCS (Multiple Chemical Sensitivity) dude and usually develop side effects to drugs and often a dependency too, so I would need strong evidence in support of using even more drugs. I’m all about trying to replace chemical solutions with lifestyle and diet, so thanks for the info and the great start to managing this issue.
Your doctors are mis-advising you to consider pramipexole or ropinirole. It's now becoming accepted that these and/or rotigotine should not be the first medication of choice for RLS.
Gabapentin or pregabalin are now increasingly accepted as the first choice.
Your doctors are not up to date with RLS treatment.
In your case gabapentin or gabapentin can help relieve RLS, chronic back pain and help prevent migraine. They do not have the same longer term complications that pramipexole, ropinirole or rotigotine have. Your doctors seem unaware of these. These complications are common and major!
They may not realise, but if your doctors fail to tell you this and urge you to take one of these and you should subsequently suffer complications, it could be seen as medical negligence.
Please read the following link which is the national guidance for uk doctors on the management of RLS. You will see the guidelines explicitly instruct doctors to warn people of the complications of pramipexole, ropinirole or rotigotine., notably augmentation. Your doctors cannot ignore or dispute this, to do so would be very unwise.
You only have to read a few posts in this forum to see hiw many people have suffered significantly because of augmentation due to these drugs.
If you do choose to.substitute anything for the opiates, (i.e. instead f) or as well as the opiates I strongly suggest you do NOT consider what your doctors have said .
Gabapentin or pregabalin do NOT cause augmentation.
A slow release version of tramadol exists which is less likely to cause rebound than immediate release.
That’s interesting information about about the fact being lactose Intolerant might make RLS worse. I think I am a little lactose intolerant . When I eat ice cream for dessert which is often I find it causes my RLS at nighttime when I go to bed. Or maybe it’s too much sugar? I am not diabetic or overweight but I find when I do have too much sugar I get stomach cramps. Do you think sugar might aggravate RLS?
Hi, some people are lactose intolerant or "sensitive" which means that although they may not be "allergic" it still causes some inflammation in the gut. The symptoms of this may not be noticed. This inflammation can contribute to RLS because it may interfere with iron metabolism.
However, it's more likely that it's the added sugar in the ice cream that's your issue.
It is known that "simple" sugars (monsaccharides - sucrose, dextrose, fructose) used as a sweetener can exacerbate RLS in the short term. Also hidden refined carbohydrates in other foods can have the same effect. The likelihood of a carbohydrate making symptoms worse depends on its "glycaemic index".
In additon a regular repetitive excess intake of carbohydrates can lead to chronic inflammation and hence a longer term exacerbation of RLS, not so easily reversed. As well as heart disease, cancer, diabetes type 2 and dementia.
You may well generally benefit from a low carbohydrate diet.
However, if you really can't resist the ice cream now and again, then eating a high protein snack just before going to bed can counteract the short term effect to some extent.
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