The Appropriate Use of Opioids in the Treatment of Refractory Restless Legs Syndrome

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Research output: Contribution to journalArticle

Abstract

Restless legs syndrome (RLS) is a distinct disorder, differing from chronic pain in many ways. Refractory RLS is characterized by unresponsiveness to dopamine agonists or alpha-2-delta ligands due to inadequate efficacy, augmentation, or adverse effects. This may result in severely impaired quality of life, profound insomnia, and suicidal depression. Opioid therapy is a mainstay in the management of these patients. This article summarizes the basic science and clinical evidence in support of their use, including the positive result of a large controlled multicenter study of 306 subjects, and outlines an approach to their use in clinical practice. Treatable explanations for RLS refractoriness, such as low iron stores, and other therapeutic options, such as combination therapy, should be considered before prescribing opioids. The agents most commonly used are oxycodone and methadone, but tramadol, codeine, morphine, and hydrocodone can also be considered. Controlled-release medication should be used for evening dosage and short-acting drugs, if needed, during the day. Effective doses are considerably lower than used for chronic pain (oxycodone 10-30 mg daily; methadone 5-20 mg daily) and the risk of opioid use disorder is relatively low. However, sensible precautions should be undertaken, including assessing opioid risk with standard questionnaires, using an opioid contract, using urine drug screens, consulting state prescription drug monitoring programs, and frequent reevaluation of effectiveness and side effects. Opioid use in selected patients with refractory RLS may be life-transforming with favorable risk-benefit ratio.

Original languageEnglish (US)
Pages (from-to)59-67
Number of pages9
JournalMayo Clinic Proceedings
Volume93
Issue number1
DOIs
StatePublished - Jan 1 2018

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Restless Legs Syndrome
Opioid Analgesics
Oxycodone
Methadone
Chronic Pain
Therapeutics
Hydrocodone
Tramadol
Codeine
Prescription Drugs
Drug Monitoring
Dopamine Agonists
Sleep Initiation and Maintenance Disorders
Contracts
Pharmaceutical Preparations
Morphine
Multicenter Studies
Iron
Odds Ratio
Quality of Life

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The Appropriate Use of Opioids in the Treatment of Refractory Restless Legs Syndrome. / for the.

In: Mayo Clinic Proceedings, Vol. 93, No. 1, 01.01.2018, p. 59-67.

Research output: Contribution to journalArticle

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