Need pain med that doesn't cause RLS rebound!

[Dr. Grammy]

I have severe RLS plus arthritis. If I exert myself during the day, pain from spinal stenosis keeps me awake much of the night, even if my body isn't jerking.

I take 30 mg of methadone daily for my severe RLS (10 mg morning, 20 at night), plus as many 100 mg gabapentin as I care to take for breakthrough jerking. More than 600 mg/day of gabapentin gives me brain fog and makes it hard to walk steadily, so I try to take 600 or fewer.

I've been taking this combination 7 or 8 years and it handles the jerking pretty well, but doesn't touch the arthritis pain.

Whenever I do gardening chores and/or take a walk, pain strikes with a vengeance. I alternate Tylenol and Ibuprofen all afternoon and night, with one final dose after breakfast. Then I resume at night. But I still wake two or three hours after each dose, and cannot get back to sleep.

Last night, desperate, I took 600 mg of gabapentin between 8 pm and midnight. No relief. Four hours of sleep.

I've had excellent pain relief plus RLS relief from Tramadol and Oxycodin after each of three surgeries in the past three years, and taking half an Alprazolam helps too. Problem is, when any of these wears off I get a major RLS rebound that can last 24 hours!

So my question is: What strong pain reliever does *not* cause RLS rebound when it wears off?

[badnights]

Hi Dr. Grammy

That's a worrisome amount of acetominophen and ibuprofen to take. Prolonged daily use might cause complications down the road (e.g. liver disease ir gastrointestinal bleeding).

Anti-convulsants (gabapentin) are not of much help for arthritis pain (and I wouldn't think Alprazolam would be, either). Opioids are often not as effective as the anti-inflammatories, as I understand it, but your experience seems to show that they're effective in your case. You might want to try naproxen instead of ibuprofen; it's also a NSAID but can be more effective than ibuprofen. There are anti-inflammatory ointments, too. If you haven't ever spoken with your doctor about arthritis pain relief, or if it's been a while, you should probably make an appointment to discuss it.

I don't get rebound WED/RLS from anything except levo-carbidopa, which I use only occasionally for breakthrough symptoms. I take hydromorph contin regularly, and have no rebound from that. The opioids don't generally cause rebound; I'm at a loss, there. Hopefully someone else can comment too.

[Dr. Grammy]

Thank you! I'll give naproxen a try. I have an appt. to see my PCP, but it's not until mid-September.