Restless Legs Syndrome (RLS) Discussion Board

I just met with my neuro on Monday. He will continue 3x50mg Ultram for the next 6 months and gave me a referral to a pain center if I want to try Oxycodone. Since all the DA don't work for me but need supplementation with an opiate. I don't know whether to try Oxycodone or just stay on the ultram. I can get to sleep with ultram but it is out of my system by lunch time the next day. Does oxycodone act as a slow release in your system for 8-12 hours? Is it "better" than ultram?

I haven't tried ultram. I was on OxyContin which is a slow release version of oxycodone. It says it lasts 8 hours but actually it only lasted about 5 or 6. According to Dr. Buchfuhrer, there are those who are considering a class action (litigation) because it lasts so much less long than it says it does.

I think Oxycodone is a stronger opiate than tramadol.

So people take one before bed to allow you to fall asleep then one in the morning before you go to work? why do some doctors have no problem prescribing ultram but refer you to a pain clinic if you want to discus oxycodone?

Ultram is a lower strength opioid medication, so it seems to draw less regulatory attention than the opiates (the oxy's, hydrocodone, morphine, etc), methadone and fentanyl. The issue of the oxy's wearing off is part of the reason why some doctors prefer methadone, which has a much longer half life. Methadone also provides a bit of interaction with the dopamine receptors, so it sort of acts a bit like a low quality dopamine agonist. Methadone also has a lot of "baggage" with respect to it's use for heroine addicts. When you take a prescription to the drug store, a methadone prescription produces all sorts of strange looks.

You will definitely want the extended-release version of whatever opioid you might get. (Unless it's methadone, which has a long half-life.) Oxycontin or hydromorph contin would be the most common ones. They take longer to kick in, so be prepared for that. I use hydromorph contin, it takes about 2 hours to kick in and lasts from 4 to 6 hours after that (though it's supposed to last 12).

If Oxycontin doesn't kick in for 2 hours and still only lasts 4-6 hours why not just take the Oxycodone?

IThinkImInTorture wrote:If Oxycontin doesn't kick in for 2 hours and still only lasts 4-6 hours why not just take the Oxycodone?

Some of us find that the shorter-acting ones wear off so quickly that you end up getting only 1.5 to 3 hours sleep, wake up, have to take more, then have to wait for it to work.

It's different for everyone, you might have it last longer. You can be sure that oxycontin will last longer than oxycodone, though.

IThinkImInTorture wrote:If Oxycontin doesn't kick in for 2 hours and still only lasts 4-6 hours why not just take the Oxycodone?

It is besser to avoid short acting opioids. They tend to cause tolerance much faster then extended release Oxycodone or other extende release opioids.

For me, extended release Oxycodone similar to to U.S. Oxycontin starts working within 20 - 30 minutes. Same goes for extended release Morphine or Hydromorphone.

I take opioids 24/7 around the clock. So it doesn't really matter how much time they need to start working as long as I maintain my drug schedule I am all covered.

Also this combo pills Oxycodone with Ibuprofen / Paracetamol are not any good. The long term daily intake of drug such as Ibuprofen, Paracetamol, Aspirin, Diclofenac etc. is highly problematic.

Just pure opiods are the way to go.

I have an appointment with a pain center on Monday. I'll ask for the extended release oxycondone then.

You're probably better off not to ask for anything in particular. Some doctors get offended when you walk in and tell them what you need, as if their knowledge is irrelevant to you.

You can say you've heard that the extended release medications are much better. You can say you've heard of people using oxycontin and hydromorph contin. Do you have any valid reason for choosing oxycontin over hydromorph contin or anything else? Perhaps that selection is something you should leave to the doctor (unless you've had adverse reactions to something).

I hope it goes well for you at the pain center. You may need to describe your WED/RLS in terms of pain. The abnormal sensations we get are not always what we would call pain, by which we usually mean the sensation of damage to bodily tissues. Nevertheless, WED sensations are pain, in that they are a negative sensory experience. (Don't let any doctor tell you they're just restlessness. They are extremely negative and prevent sleep.)

It seems from reports here that pain doctors treat us pretty well, even when they don't know a lot about WED. So I'm hopeful for you

Well, I'm back from the pain center. Note, my RLS was so bad last night I didn't take my 4x 50mg Ultram but one 5mg Oxycodone at 4pm and another at midnight. I slept really well. However, the doctor said they will not prescribe me any opiod as I have severe sleep apnea. Opiates turn off the part of the brain that control sleep. So, if I stop breathing in my sleep my brain might not allow me to wake up. So they gave me Gabapentin which my current neurologist mentions has weight gain as a side effect. None the less, I took the tablet and it didn't fix my RLS so I just added the 4x50mg Ultram. I"m back to square one. I had "magnesium and other maylaise" blood work taken as they say my twitches in my leg could be due to magnesium deficiency. If the magnesium is low I will be recommended an IV of magnesium given in the office. I don't feel great about the turn of events.

Is there some way that you could find a sleep doctor who is also highly knowledgeable in the treatment of refractory RLS? You mentioned Johns Hopkins early in this thread. Many of the doctors in their RLS clinic are also sleep medicine experts. My thought is that possibly a sleep doctor who understands the need to treat your RLS with an opioid medication could also prescribe the use of an ASV machine to treat your OSA rather than a simple CPAP or BiPAP machine. As I understand the ASV machines, they are sort of like mini-ventilators that detect the central apneas that can be caused by opioids (and other things) and the machine then increases the pressure to sort of kick start your breathing. I could be completely wrong about this, but it might be worth investigating. Generally a doctor doesn't want to prescribe a med that could enhance central apneas, but when the choice is the med or a patient who is either insane or who becomes so depressed that suicide becomes a very real option, it is time for that doctor to reexamine their normal practices.

I just emailed my CPAP supplier, BPGamma, to see if I could upgrade to a ASV. We shall see what the response will be very soon. I currently don't use the CPAP machine as it is uncomfortable and it makes my RLS worse.