Restless Legs Syndrome (RLS) Discussion Board

Totally understand ViewsAskew ... my only other theory is a pinched nerve in my lower back. The trippy thing is the rls set in about 2 to 3 months after my car accedent. What's the story on opiates? Not really interested in being a statistic in the epidimic, however the maripex and gabapentin combo I'm on ain't cutting it. I'm miserable all night until 3:30 in the morning. I'd give my pinkey toe to have a good night's sleep.

RLS Ouch, opioids are generally reserved for use in patients with refractory RLS. Refractory RLS is RLS that does not respond to dopamine agonists and the alpha-2-delta meds, or for patients who cannot take these due to unacceptable side effects. Generally, doctors want you to "fail" at least two meds in each category before trying opioids because there is currently no other option past opioids. It can also be a challenge to find a doctor who is willing to write the prescriptions unless you have one who is really up-to-date on the treatment of RLS. Even filling the prescriptions can be challenging with all the hysteria surrounding opioids these days. And even once you start them, there is no guarantee that the first one that you try will work for you. Each opioid has it's own set of side effects and it could take a couple of tries before finding one that works and can be tolerated.

As for the hysteria, the opioid dose used to treat RLS is very low when compared to what they give for chronic pain or even drug rehab. As a result, the chances of true addiction are not zero, but are very small, provided that you do not have a past history with some form of addiction.

Believe it or not antipsychotics are supposed to balance out the brain chemicals for people with psychosis. In some cases blocking dopamine can lead to dysfunction in the way those chemicals are released even after the medication is discontinued. RLS and other neurological disorders can result. What needs to happen for my brain to function properly is the dopamine receptors needs to realeace the antipsychotic. It's been 6 months sense I stopped the antipsychotic and still left with rls every night. I take a half of a .125 maripex and 1500mg of gabapentin at night. Any ideas from the group as to how to get my brain to balance back out.

I have a suspicion that it might take longer than 6 months for some of us to remove the effects of taking meds that mess with our dopamine system. But I have no evidence for that - just the long-term (permanent?) worsening so many of us have experienced after augmenting on dopamine agonists (DAs).
Your ongoing problems might be related to augmentation from the Mirapex. It can begin in under a week after starting a DA for some people. Please read up on augmentation - the Foundation has some good brochures, I forget which are free and which require a membership, I have put instructions to find them in the page you can get to by clicking the link in my signature line under every one of my posts. I also have papers there that indicate the need to have high ferritin levels to avoid symptoms severity and augmentation on DAs. Have you had your serum ferritin checked? It should be above 75 at least, preferably 100.

I would suggest you get your serum ferritin checked along with a complete iron panel, and provide your doctor with information on augmentation, tell him you want to get off the Mirapex. I doubt he/she will suggest opioids, but there is good reason to take low-dose opioids in many cases, as Steve has indicated. The Foundation's Medical Bulletin for healthcare providers indicates this quite clearly.

I hope this all works out for you.