Narcotics...How Do They Work?
Narcotics...How Do They Work?
Well everyone, my sciatic pain which is worsened by my leg muscles tightening at night is increasing. I'm currently taking 1200mg gabapentin and .75mg clonazepam each night, along with .5mg clonazepam each morning. I sleep very lightly, waking at around 3am, and then going into a semi-sleepy state during which I'm vaguely aware of "stretching" my legs to relieve the muscular tension. Requip makes me nauseous, and along with Mirapex, keeps me from sleeping at all. I want to ask my primary care Dr. for a prescription of a narcotic, but I need to know how they work, so that I have a better chance of "selling" the doc on the idea. Do they control rls and/or plms? Do they help us to sleep? Do they help with any pain associated with our condition? I know that low and/or high potency narcotics are a part of the Mayo algorithm, and I know that those of us who use them seem to get good results, but I need to know if they're a reasonable alternative to the meds I'm currently taking for the symptoms I have. Any help here would be appreciated. Thanks. --Andy
narcotics work on your central nervous system, they basically tell your brain you are having no pain. i am sure if you do a google search on how narcotics work you can get a more in depth description, but i just gave you the cut and dried version 
my neuro has me on oxycontin. 40mgs a day.
dee
my neuro has me on oxycontin. 40mgs a day.
dee
I feel like a science project!!!
“The syndrome is so common that it should be known to every physician.”
Dr Karl Ekbom, 1945
“The syndrome is so common that it should be known to every physician.”
Dr Karl Ekbom, 1945
Thanks for responding Dee,
I know that basically narcotics are used for pain, but I'm trying to figure out how they work on symptoms related to RLS. I'll try to google-search it, and see if there is any info on that relationship. In your case, why was the oxycontin prescribed? RLS? Neuropathic pain? Something else? And how is it working? If I'm gonna ask my md to prescribe something, I need to know what I'm asking him to treat. He'll have to justify it with my HMO, and I only want to make him more comfortable in prescribing it. I know many posts here have talked about how they've been able to sleep at night and function during the days while taking methadone, oxycontin, etc., but I'm not sure I know what symptoms they had that have been treated successfully by the narcotics. Thanks again, and have a great day! ---Andy
I know that basically narcotics are used for pain, but I'm trying to figure out how they work on symptoms related to RLS. I'll try to google-search it, and see if there is any info on that relationship. In your case, why was the oxycontin prescribed? RLS? Neuropathic pain? Something else? And how is it working? If I'm gonna ask my md to prescribe something, I need to know what I'm asking him to treat. He'll have to justify it with my HMO, and I only want to make him more comfortable in prescribing it. I know many posts here have talked about how they've been able to sleep at night and function during the days while taking methadone, oxycontin, etc., but I'm not sure I know what symptoms they had that have been treated successfully by the narcotics. Thanks again, and have a great day! ---Andy
Andy, the weird thing about narcotics is that while we understand their pharmacology, researchers really don't completely understand how the nervous system works. Scientists currently know that there are at least 5 different opiate receptors in our central nervous system and that when an opiate binds to those receptors, it causes the neurons in those areas to "hyperpolarize". This hyperpolarization causes the neuron to cease "firing" and thus retard or stop the signal that is normally sent across it. So in a sense, narcotics work for RLS as they do with any other "uncomfortable" feeling, they block or slow the bodies ability to perceive that you are uncomfortable. On the other side of that coin, however, is the interesting part for me. Opiates, to varying degrees, cause a release of dopamine into the nervous system... and some think that perhaps this is why these drugs way work for RLS. This is why I've always been irritated with medical professionals who claim that ONLY dopamine agonists like requip and mirapex work.... they perceive that they are treating their patient's "dopamine deficiency" . In reality, narcotics may contribute in their own magnificent way to this dopamine argument. In one pill a day, I get BOTH a nice burst of dopamine that stops my legs from jerking AND the added benefit of pain cessation from neuronal blockade. I just wish I knew why Emily wasn't getting the same results.... 
Josh
-
ViewsAskew
- Moderator
- Posts: 16585
- Joined: Thu Oct 28, 2004 6:37 am
- Location: Los Angeles
To add to Josh's great summary, they don't even understand how RLS works yet. . .so it's hard to know how the opioids are contributing.
That said, the latest "breakthrough" had been that they think the spinal cord is involved - this gives more credence to why the opioids would work, as it's more of a CNS issue than it would be just if RLS was oriented ONLY in the substantia nigra. I think that makes sense. . . .
That said, the latest "breakthrough" had been that they think the spinal cord is involved - this gives more credence to why the opioids would work, as it's more of a CNS issue than it would be just if RLS was oriented ONLY in the substantia nigra. I think that makes sense. . . .
Ann - Take what you need, leave the rest
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Managing Your RLS
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.
Andy to answer your question why dr put me on oxycontin, because ultram wasn't working for me. I have a high tolerance for pain meds in the first place, don't know why i just do. dr first had me on 2 10mg oxy's a day, that worked for a month and then it was lasting only a couple of hours instead of all day. So he upped it to 20mg twice a day, so far that has worked ok for me and it doesn't make me loopy or sleepy during the day. i also take sinemet, but only when my legs are really bad, because from what i have read taking sinemet everyday can make your rls worse. my rls is all day long and all night long with out pain meds, it's not just a night time thing. also on klonopin for sleep at night. like ann said they really don't know how rls works, and some narcotics works for some people and some they don't. it's like a crap shoot on meds.
dee
dee
I feel like a science project!!!
“The syndrome is so common that it should be known to every physician.”
Dr Karl Ekbom, 1945
“The syndrome is so common that it should be known to every physician.”
Dr Karl Ekbom, 1945
Fidgetboy,
Thanks to your explanation, I think I now understand (and can approach my md for a Rx) how opiates can help RLS and pain. The dopamine-releasing properties of the opiates explain why symptoms of RLS can be reduced or eliminated, much like they are with DA's like Mirapex and Requip. In the Mayo algorithm, my symptoms are more intermittent than 24/7...with most symptoms at night and in the early morning hours. Periodically, I find it difficult to sit at my desk at work, or sit in my car for more than 45 minutes without the need to get up and move around. I have a painful (burning/aching) idiopathic neuropathy which is increasing, and the extent to which I can keep my mind occupied with other things, determines how well I can deal with this pain. I can't ignore or distract myself from the RLS symptoms, however.
To all of you who have been so thoughtful to respond to my questions, I can't begin to thank you. My thoughts and prayers go out to all who suffer from this baffling disease. Let's all hang in there, and try to have a good day. ---Andy
Thanks to your explanation, I think I now understand (and can approach my md for a Rx) how opiates can help RLS and pain. The dopamine-releasing properties of the opiates explain why symptoms of RLS can be reduced or eliminated, much like they are with DA's like Mirapex and Requip. In the Mayo algorithm, my symptoms are more intermittent than 24/7...with most symptoms at night and in the early morning hours. Periodically, I find it difficult to sit at my desk at work, or sit in my car for more than 45 minutes without the need to get up and move around. I have a painful (burning/aching) idiopathic neuropathy which is increasing, and the extent to which I can keep my mind occupied with other things, determines how well I can deal with this pain. I can't ignore or distract myself from the RLS symptoms, however.
To all of you who have been so thoughtful to respond to my questions, I can't begin to thank you. My thoughts and prayers go out to all who suffer from this baffling disease. Let's all hang in there, and try to have a good day. ---Andy
andy thats why i have to take the pain meds, because i couldn't make it through work. sitting in an office chair all day, even with the pain meds still hurts, and i have to get up and pace the office. we all know how you feel. hang in there, and good luck with your dr.
dee
dee
I feel like a science project!!!
“The syndrome is so common that it should be known to every physician.”
Dr Karl Ekbom, 1945
“The syndrome is so common that it should be known to every physician.”
Dr Karl Ekbom, 1945
dee,
Thanks again for your help...and for your encouragement. This forum really is populated with great people. And the really great thing here is that we all share a common problem, and we all are in a position to support and help each other. By the way, I think I found a great way to work at my keyboard while standing at my desk...I'm gonna ask my boss if I can put a motorcycle jack under the desk to raise it high enough to work when my rls gets out of hand.
Emily, I wish that you could find the RX, (either medications or non-medicinals), which would help you with your symptoms. I keep trying the DA's, but the side-effects...dizziness, weight gain, rebound, augmentation, etc. always outweigh the benefits. I'm not even sure that I can tolerate narcotics...I'm pretty sensitive to adverse effects of many medications...but I'll still ask my primary care doc about a RX for one of them. Well, I hope everybody has a great day! ---Andy
Thanks again for your help...and for your encouragement. This forum really is populated with great people. And the really great thing here is that we all share a common problem, and we all are in a position to support and help each other. By the way, I think I found a great way to work at my keyboard while standing at my desk...I'm gonna ask my boss if I can put a motorcycle jack under the desk to raise it high enough to work when my rls gets out of hand.
Emily, I wish that you could find the RX, (either medications or non-medicinals), which would help you with your symptoms. I keep trying the DA's, but the side-effects...dizziness, weight gain, rebound, augmentation, etc. always outweigh the benefits. I'm not even sure that I can tolerate narcotics...I'm pretty sensitive to adverse effects of many medications...but I'll still ask my primary care doc about a RX for one of them. Well, I hope everybody has a great day! ---Andy
I forgot to ask this regarding narcotics...I'm gonna have to assume that my non-neuro md might not know how to go about prescribing a narcotic for rls...which one and what dosage. I know that many of you have mentioned on other threads which ones you tried, and the dosages that worked for you. So, would any of you tell me which one might be a good one to try for intermittent daytime rls, and nearly every night PLMS and muscular tension which really bums out my right leg sciatic nerve in the early morning hours. I need to get in my car by 5:30 am to drive the 32 miles to work, and so I need to ask if any of you felt impaired in your ability to drive while taking oxycontin, methadone, etc. I really don't have any experience with this class of medication, except Tylenol 3 for post-surgical pain (and it wasn't very effective for me). I don't even know the brand name/generic equivalents of most of the available narcotic meds being used for rls symptoms. I'm not asking any of you for recommendations...only comments on your experiences so that I might be able to ask my md for a reasonable medication which might help me to get more than 3-4 hours sleep each night. I'm afraid that (like many of you) there is a lot of my life that's being affected by this disease and the sleep deprivation that it causes. Thanks a bunch. ---Andy
Andy- The lower potency narcotics are the way to go when you first start out, if only to see what your tolerance is. Some folks are extremely sensitive to narcotics. The first step is determing how many hours a day your symptoms actually occur. If it's </= 6 hrs, you can consider the short acting narcotics...A good place to start is tramadol (Ultram). It is an unusual drug in that it is partially a narcotic but also partially a antidepressant like med... it has less of a potential to cause addiction and is supposedly less sedating. (as a rule, doctors feel better about prescribing this drug) Be forwarned however, that it HAS worsened RLS in a minority of patients. Other good shortacting agents are small doses of oxycodone (1/2-1 tab) or maybe a 1/2 tab of vicoden (this contains tylenol). If your symptoms are for longer then 8 hrs a day, you may need to consider a long acting narcotic like oxycontin or methadone, both of which are pretty strong. What you'll need to do is what most of us had to do when we started these meds--- trial and error. Take small doses and see if your RLS responds... increase your doses slowly and eventually you will target in on what your body needs. Good luck!
Josh
Oxycontin=long acting oxycodone, so it's a higher dose. Other then that, they are identical. I can't really say if a higher dose would help you, Em, I wish I could say.... Dr. B has more experience with narcotics and RLS then I do. My experience is only with patients with acute/chronic pain syndromes. I'm curious if Dr. B thinks that if you have not responded at this point, if he thinks narcotics are not the option for you? Have you asked him if he's had patients like you in the past?
Josh