You were pretty sure you had it. Still, it was good to get the diagnosis. Are you looking for more restless legs syndrome info? Maybe cause, treatment? Here’s what you need to know…
Dopaminergic agents: These drugs, which increase dopamine in the brain, can reduce symptoms of RLS when taken at night.
If you or someone you care about has restless legs syndrome, you know how troublesome it can be.
You also know it doesn’t get the attention it deserves.
We started a two-part series on restless legs syndrome last week. In part one we defined it, reviewed its symptoms, and who’s more likely to have it.
Now it’s on to cause and treatment…
What causes restless legs syndrome
Like most of the conditions we discuss, the cause of restless legs syndrome (RLS) is unknown. That means we have to turn to triggers and scientific supposition to connect the dots.
If someone is experiencing RLS-like symptoms and any of the following are going on, the dots are connecting…
Family history of RLS
Parkinson’s disease/dopamine imbalance
Neuropathy
Sleep deprivation and other sleep conditions, such as sleep apnea
Pregnancy or hormonal changes, especially in the last trimester
Use of alcohol, nicotine, and caffeine
Iron deficiency, even without anemia
Using medications, such as some anti-nausea drugs, antidepressants that increase serotonin, antipsychotics, medications that contain older antihistamines
End-stage renal disease and hemodialysis
What’s in the works?
Lots of mystery, supposition, and dot connecting going on when it comes to the cause of RLS. It’s terribly frustrating. But what can I say? It’s the brain.
The good news is the National Institute of Neurological Disorders and Stroke (NINDS) is funding a lot of fantastic research.
“Yeah, participating in a clinical trial is a great way to help the cause. Good idea, doc.”
Included: investigating changes in the brain’s signaling pathways with an emphasis on dopamine, discovering genetic relationships, studying the role of endothelial cells in the regulation of cerebral iron metabolism, using advanced MRI to measure chemical changes in the brain’s arousal system, testing non-drug therapies, such as a non-invasive nerve stimulation device to use during sleep.
If you’re dealing with it, you know that’s the kind of attention RLS deserves.
How is restless legs syndrome treated?
There is no treatment that directly addresses RLS. So to secure relief we have to focus upon contributing medical conditions, lifestyle habits, and self-care.
Medications
Let’s start with medical conditions – reference the “triggers” above. Here are medications frequently used in the treatment of RLS…
Iron supplements: Check with your physician first.
Anti-seizure drugs (anticonvulsants): The first-line prescription drugs for those with RLS. The U.S. Food and Drug Administration (FDA) approved gabapentin enacarbil (Horizant, Regnite) for the treatment of moderate to severe RLS. Other anti-seizure drugs, such as pregabalin (Lyrica), can decrease sensory disturbances and nerve pain.
Dopaminergic agents: These drugs, which increase dopamine in the brain, can reduce symptoms of RLS when taken at night. Ropinirole (Requip), pramipexole (Mirapex), and rotigotine (Neupro) are FDA-approved to treat moderate to severe RLS. Levodopa (L-Dopa) plus carbidopa (Lodosyn) may be effective, but can only be used intermittently.
Opioids: Drugs such as methadone (Dolophine, Methadose), codeine, hydrocodone (Hysingla ER, Zohydro ER), or oxycodone (OxyContin, Roxicodone) are sometimes prescribed to treat individuals with more severe symptoms of RLS who do not respond well to other medications.
Benzodiazepines: They are anticonvulsants. Medications such as clonazepam (Klonopin) and lorazepam (Ativan) are generally prescribed to treat anxiety, muscle spasms, and insomnia; and can help individuals get more restful sleep.
Lifestyle habits and self-care
Lifestyle habits and self-care have a major impact on distress. The following often provide relief for those with mild to moderate RLS…
Avoid or decrease the use of alcohol, nicotine, and caffeine
Change or maintain a regular sleep pattern
Moderate, regular exercise
Massage the legs or take a warm bath
Apply a heating pad or ice pack
Use foot wraps specially designed for people with RLS or vibration pads to the back of the legs
Aerobic and leg-stretching exercises of moderate intensity
With creativity, we can come up with more.
The attention it deserves
That’ll do it for our series. Restless legs syndrome makes life challenging for tens of millions worldwide. If you or someone close to you has it, that isn’t front page news.
No cause, no cure. So quality management options will have to hold us over as research continues.
But there’s plenty of hope because restless legs syndrome is finally getting the attention it deserves.
To get the full scoop on restless legs syndrome, be sure to read part one.
Like our friend with his doc, if your interested in participating in a clinical trial for RLS, or any other disorder, start with NIH Clinical Trials and You. When you’re ready to find a trial, visit ClinicalTrials.gov.
Would you like to read more Chipur mood and anxiety info and inspiration articles? Head to the titles.
Bill White is not a physician and provides this information for educational purposes only. Always contact your physician with questions and for advice and recommendations.
You’ve been having strange sensations in your legs and overpowering urges to move them. You can’t even sleep anymore. “Do I have restless legs syndrome?” Here’s what you need to know…
Do you think there’s a relationship between RLS, depression, and anxiety? Sure is. And one incites the other.
Restless legs syndrome can turn lives upside down.
If you’re one of the tens of millions struggling, or think you may be, here’s what you need to know. In fact, there are so many need to knows that we’ll go with a two-part series.
Let’s get after defining restless legs syndrome, reviewing its symptoms, and who’s more likely to have it. And we’ll come back in part-two with causes and what to do about it.
Off with us…
What is restless legs syndrome?
Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a neurological disorder characterized by unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them. It can also affect other parts of the body.
The occurrence rate of RLS in North America and Europe is 7-10%. It’s believed to be quite a bit lower in Middle Eastern and East Asian countries.
What are the symptoms of restless legs syndrome?
Here are the primary symptoms – characteristics – of RLS…
Sensations – aching, crawling, tingling, itching, throbbing, pain, burning, tugging – that typically begin after being inactive and sitting for extended periods of time.
Relief of discomfort with movement of the legs (or other affected body part). Keeping them in motion may minimize or prevent the sensations. It may come down to pacing the floor or constant movement while sitting.
Worsening of symptoms at night with a distinct symptom-free period early in the morning.
Difficulty falling and staying asleep, which can worsen with a reduction of sleep due to events or activity.
With moderately severe RLS, symptoms may only occur once or twice a week, but often result in significant delay of sleep onset with some disruption of daytime functioning.
Periods of remission may occur for weeks or months, especially during the early stages of the disorder. But not only are they likely to reappear, they can become worse over time.
By the way, can you see why RLS is considered both a sleep and movement disorder?
Severe cases
“I love this show, but enough’s enough. It’s time to see the doc.”
Some 3% of RLS cases are considered severe, which means intense and persistent symptoms occur more than twice a week.
In addition to sensations and movement, mental distress, insomnia, and daytime sleepiness may present. And since RLS is worse when resting, those with severe cases may avoid daily activities that involve long periods of sitting.
But that’s not all. Sufferers of severe RLS are more apt to isolate socially and experience frequent daytime headaches, compromised memory, impaired concentration, and libido issues.
Do you think there’s a relationship between RLS, depression, and anxiety? Sure is. And one incites the other.
Who is more likely to have restless legs syndrome?
Just like our specialty, the mood and anxiety disorders, the root cause of RLS is unknown. When that’s the case, triggers help us identify who’s more likely to have a disorder.
Let’s take a look…
Family history of RLS
Neuropathy
Sleep deprivation and other sleep conditions, such as sleep apnea
Use of alcohol, nicotine, and caffeine
Pregnancy or hormonal changes, especially in the last trimester. In most cases, symptoms disappear within four weeks post-delivery.
Parkinson’s disease
Medications, such as anti-nausea drugs, antipsychotics, antidepressants that increase serotonin, cold and allergy medications that contain older antihistamines (e.g., chlorphenamine, doxylamine, hydroxyzine)
Iron deficiency, even without a diagnosis of anemia
End-stage renal disease and hemodialysis
Heads up, right?
Come on back for part two
That’ll do it for part one. Whether you know you have restless leg syndrome or you’re considering the possibility, the information will lend you a hand.
If you’re interested in participating in a clinical trial for RLS, or any other disorder, start with NIH Clinical Trials and You. When you’re ready to find a trial, visit ClinicalTrials.gov.
Your chronic pain is relentless, you don’t want to rely on meds, and you’re anxious and depressed. Wisely, you’ve decided to learn about psychological interventions. Say no more…
Dr. Darnall submits that psychological treatments should be first-line, applied early, and not just recommended after meds and/or physical treatments don’t deliver.
The article detailed my induction into the chronic pain club. And we took a look at a new study that reviewed how folks with chronic pain can protect their mental wellbeing.
For yet more helpful info, let’s do part two…
”Psychological Interventions for the Treatment of Chronic Pain in Adults”
I found a fabulous article in the journal, Psychological Science in the Public Interest.
“Psychological Interventions for the Treatment of Chronic Pain in Adults,” published in September of 2021, was written by a high-powered team of psych researchers led by Dr. Mary Driscoll.
Highlights are in order…
What is chronic pain?
The team kick things off with the International Association for the Study of Pain’s definition of chronic pain: “…ongoing or recurrent pain that lasts beyond the usual course of acute illness or injury or for more than 3 to 6 months and adversely affects an individual’s well-being.”
They went on to make these observations…
Chronic pain is commonly viewed as a symptom, but can also be seen as a disease.
In many cases, the underlying biology of chronic pain are unknown, therefore medical interventions might not be beneficial.
People with chronic pain often report frustrations with health care systems and health insurance.
And perhaps the most important observation: the significant negative consequences of chronic pain go beyond physical suffering, affecting wellbeing, emotional functioning, and overall quality of life.
Those of us tussling with chronic pain know that all too well.
The biopsychosocial model of chronic pain
“The pain is excruciating. And my anxiety, depression, and social life aren’t much better.”
To explain its complexities, the team use the biopsychosocial model of chronic pain.
That’s significant because It emphasizes the interrelatedness of biological, psychological, and social factors.
And wouldn’t you know it, the biopsychosocial model is recognized as the foundation for the study of pain and the clinical practice of pain management.
Chronic pain and mental health: Psychological interventions
The team point out that a variety of psychological factors play a role in the onset, maintenance, and exacerbation of chronic pain. And a variety of psychological interventions are used to treat them.
Here are the interventions most widely accepted within the pain-care community…
Supportive psychotherapy: emphasizes unconditional acceptance and empathic understanding.
Relaxation training: uses breathing, muscle relaxation, and visual imagery to counteract the body’s stress response.
Biofeedback: uses biofeedback equipment to monitor physiological responses to stress and pain and teaches how to down-regulate the body’s physiological responses.
Hypnosis: involves a clinician’s hypnotic suggestion to reduce pain and incorporates relaxation training.
Operant-behavioral therapy: seeks to replace maladaptive behaviors consistent with the “sick” role with healthier “well” behaviors.
Cognitive behavioral therapy: identifies and seeks to change maladaptive thoughts about pain that cause distress and unhelpful behaviors, such as isolation and withdrawal; promotes the development of helpful behavioral coping strategies (e.g., relaxation).
Acceptance and commitment therapy: encourages acceptance of chronic pain and focuses on strategies for identifying and reinforcing behaviors consistent with the desired goals.
Mindfulness-based interventions: aim to disentangle physical pain from emotional pain via increased awareness of the body, the breath, and activity.
Emotional-awareness and expression therapy: highlights the interconnectivity of brain regions responsible for processing physical pain and emotions; encourages confronting avoided emotions to reduce the connection between emotions and pain.
Keep in mind, sex, gender, and sociocultural factors may present differences in risk for pain, suboptimal treatment, and poorer pain outcomes.
If it hasn’t already crossed your mind, I suggest that you use the list as a screening tool for current and future care providers.
It’s simple. If they have a profile available, look for your therapy of choice. No profile? Give them a call: “Are you qualified in _____?”
Integrated pain care
“Yeah, it still hurts. But having a care team on my side makes a huge difference.”
The team noted that in 2016 the U.S. Department of Health and Human Services published its National Pain Strategy (NPS).
The NPS calls for “integrated pain care” and defined it as “the systematic coordination of medical, psychological, and social aspects of health care.”
That’s right, the biopsychosocial model. Seems to be a lot of it going around. And that’s a good thing.
Critical role for psychology
According to the team, all models of pain-care delivery that comply with NPS recommendations suggest a critical role for psychology in treating chronic pain.
Now, there are bound to be issues with psychology being a major player. Well, barriers will have to be torn down.
Speaking of which: patients not recognizing the benefit of psychological treatments, stigma toward mental health treatments, providers misunderstanding the rationale and mechanisms of psychological treatments, inadequate insurance coverage to ensure timely and equitable access to treatments.
Time to rephrase
The team included an insightful commentary from Dr. Beth Darnall.
Dr. Darnall submits that psychological treatments should be first-line, applied early, and not just recommended after meds and/or physical treatments don’t deliver.
It gets even better. She believes describing psychological treatment as “pain coping skills” is often misinterpreted by patients as “learning to cope with pain.”
According to Darnall, that’s a problem and it’s time to rephrase. She says the most accurate description of psychological treatment is “…directly reducing the intensity of pain and favorably shaping the nervous system toward relief.”
A mouthful, but she’s spot on.
We all need support
None of us have to endure chronic pain alone – even if we live alone. I mean, we all need – deserve – support.
In addition to groups you may find on, say, Facebook, see what’s up in these neighborhoods…
Let’s see, relentless chronic pain, trying to go easy on meds, anxious and depressed, dicey social life. Absolutely, it’s time for psychological interventions.
Your hands were already full managing mood and anxiety symptoms. But chronic pain sunk its claws in and your emotional and mental health took a massive hit. Let’s see what we can do about it…
…the study showed pain interference was more problematic than pain intensity for people living with chronic pain.
I began to experience occasional pain in my hip last summer. No big, I’d shake it off and keep rolling.
Well, it worsened over time, so I finally checked in with an ortho six weeks ago. Thirty days and an MRI later: fractured femur, osteoarthritis, torn tendon – dang.
Chronic pain has sunk its claws in. And that’s a massive hit to my already, shall we say, “interesting” emotional and mental health.
Sharing is crucial
I’m learning all I can about what’s going on in my body and mind. And sharing is crucial because 20% of the world’s population – five billion people – are dealing with chronic pain.
And did you know depression and anxiety affect people with chronic pain three times as much as those who are pain free?
We have a lot of work to do and we’ll handle it in two parts. Let’s get part one, a discussion of a new study, underway…
“Protecting mental wellbeing in people with chronic pain”
Not long after I started my fact-finding I bumped into a helpful article. “Being flexible is key to protecting mental wellbeing in people with chronic pain” appeared on the Edith Cowan University (ECU) website.
The piece summarizes a new study, the work of ECUs Tara Swindells and Professor Joanne Dickson.
The details
Swindells and Dickson surveyed 300 people who were living with non-cancer-related chronic pain. The participants replied to questions about their mental wellbeing, the intensity of their pain, and how much pain interfered with their daily routines and activities they enjoy – pain interference.
Dickson observed that the study results suggested people might not have the psychological and/or physical capacity to participate in activities that help them reach their personal goals as a result of pain.
And, of course, that can have significant implications for mental wellbeing.
According to Dickson…
The good news is that this research showed personal goal flexibility (i.e., the ability to adapt and to adjust to life’s difficulties and obstacles) in how we strive to maintain or achieve the things that matter to us can provide a protective buffer in maintaining and promoting mental wellbeing.
Protection, then, comes with flexibility.
The mental health impact
“Man, those claws won’t let go – it’s chronic. I’m bummed, edgy, and really need help.”
Though Swindells predicted the opposite, the study showed pain interference was more problematic than pain intensity for people living with chronic pain.
Makes sense to me.
That being the case, in the presence of high intensity pain, people can amp up their mental wellbeing by findings ways to minimize interference with important aspects of their daily lives.
Don’t you think that calls for an intervention target adjustment?
The flexibility factor
The study investigated how goal tenacity – persistently pursuing valued goals – and goal flexibility – adjusting them in response to setbacks or obstacles – might help to explain how some people with chronic pain maintain a sense of mental wellbeing.
So the study, for the first time, determined that goal flexibility and goal tenacity appear to provide a defense against pain interference – flexibility more so than tenacity.
Swindells…
So if you’re able to adjust, adapt and find ways to still achieve what matters to you most in the face of life’s obstacles, that’s going to help protect your mental wellbeing.
That’s why working on flexibility has to be an ongoing priority.
Multi-faceted
Swindells emphasized that pain management and mental health are multi-faceted. She went on to note that previous pain-related research has shown that physical factors (e.g., sleep, injury, disease) and social factors (e.g., employment, social support, economic factors) play a significant role in pain management.
Swindells summarizes…
The findings from our study add to this body of knowledge. They indicate that variations in adaptive psychological processes provide another useful lens to understand the relationship between pain interference and mental wellbeing.
And there you have it.
All is not lost if…
Okay, chronic pain sunk its claws in you. And it’s a massive hit to your emotional and mental health. Just keep in mind, all is not lost…
You know you blew it. You waited three months for the appointment and accomplished nothing. You didn’t do any mood, anxiety, symptom tracking – so you couldn’t help your cause.
It’s an Informed and well-planned course that leads to freedom from symptom hell.
Whether it’s an initial or follow-up appointment with a therapist or psychiatrist, we need to be prepared.
Psychotherapy and meds can do wonderful things. But we’ll be excluded from the fun if we don’t pay heed to, and track, the manifestations of what ails us.
Acceptance can be a formidable opponent.
The power of symptoms
Depression, bipolar disorder, anxiety disorders, OCD – symptoms in our neck of the woods can be brutal.
If we’re depressed, it can be rock-bottom motivation, fatigue, feeling worthless and hopeless, and thoughts of self-harm.
Bipolar disorder? In addition to depressive symptoms, maybe it’s racing thoughts, no need for sleep, pressured speech, and flirting-with-disaster behavior.
Anxiety? Could be panic attacks, agoraphobia, irrational fears, avoidance, worry, and restlessness.
OCD? Perhaps a hypervigilant mind, washing, checking, arranging, counting, and intrusive thoughts.
Open the door to relief and healing
Who would want to experience any of those symptoms? But since we’re the lucky ones, let’s make them work for us.
Believe it or not, each and every symptom we experience can open the door to relief and healing. However, it stays closed and locked if we don’t observe, track, and chart them.
How else are we supposed to learn about ourselves and receive help?
Know the seas
It’s an Informed and well-planned course that leads to freedom from symptom hell. And we can’t chart our way to port if we don’t know the seas.
One may say, “Don’t know the seas? I sail them every day.” Of course, but it’s so easy to become distracted, overwhelmed, and lost. And when that happens, need to know information sinks to the bottom.
Mood, anxiety, symptom tracking
“The details of my mood, anxiety, and symptoms? Yeah, okay. Help, I need a system.”
If you’re a regular Chipurreader, you know how strongly I feel about self-observation and taking notes.
Enter mood, anxiety, symptom tracking.
It provides a system that’ll keep us, and our efforts, organized. Really, it’ll make life so much simpler. And you know how valuable that is.
But if it’s to stand a chance of coming through for us, we need a repetition and follow-up mindset. Going through the motions won’t cut it.
I’ll share some resources in a short.
Connecting the dots
All sorts of factors influence our emotional and mental health experience – meds, diet, exercise, meditation, stress, substance use, sleep, medical issues, and more.
They all need to be taken into account as we track our symptoms. That’s how we connect the dots.
Tracking resources
Certainly you can come up with your own tracking and recording methods, but maybe you’d like some assistance.
I did a bit of digging and found some worksheets and apps you’ll likely find helpful. For the record, I don’t make a dime from clicks and purchases…
Daylio: Features a mood diary and happiness tracker. Can export PDF or CSV documents to share, print, and analyze.
eMoods: Handles it all, and said to be a particularly good choice for bipolar disorder and PTSD. Enhances doc visits with detailed data exports.
MoodKit: Draws upon principles and techniques of cognitive behavioral therapy (CBT). Can be used to amp up professional treatment.
Worry Watch: Reportedly a good choice for anxiety disorders. Features a guided anxiety journal, coping techniques, mood journal tracker, and positive affirmations.
Bearable: From a user: “With Bipolar, ADHD, anxiety, and depression, this app has made it extremely easy to know, for myself, what to tell my mental health providers regarding my care – what will help me going forward.” Also works well for physical ailments.
Moodfit: Based on the relationship between thoughts, feelings, and behaviors. They say, “Help your therapist help you.”
Plenty more worksheets and apps where these came from. However, the ones I’ve shared receive a lot of attention and accolades.
And with the apps, doesn’t the ease of getting one’s provider involved make good sense? I mean, the more they know, the better they can help.
Work hard for the cause
No more blown appointments, okay? If we want to learn about ourselves and secure relief, we have to work hard for the cause – us.
Using mood, anxiety, symptom tracking is irreplaceable.
Would you like to read more Chipur mood and anxiety info and inspiration articles? Just peruse the titles.
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