How Opioids Work for the Treatment of RLS/WED??

[crl363]

Here is a possible explanation on how opioids work for the treatment of RLS/WED. I shared some of it with Beth and most of it with Dr. Allen. The foundation is based on scientific publications. This is just one persons opinion which is why I posted in the General Topics.

We know RLS patients typically need opioids to come off of a high dose dopamine agonists (DA) but we don’t know how they work. If we take the concept from published reports that opioids inhibit GABA and increase dopamine levels, then apply to the treatment of RLS, it may explain how opioids work in relieving RLS symptoms.

The hypothesis is based on my belief that increasing dopamine levels cause increasing GABA levels. GABA is a major inhibitory neurotransmitter. It is possible that when a person with RLS takes a dopamine agonist, which increases dopamine, it also increases GABA but not to its complimentary levels of dopamine? RLS symptoms are alleviated but are (“effective for only a limited period of time”). Why? The body needs more time to increase GABA levels so as to catch up to dopamine levels in order to maintain homeostasis. GABA levels finally reach complementary dopamine levels and inhibit them. RLS symptoms come back (augmentation?) and there becomes a need to up the medication dose again. The process continues to cycle requiring a shorter time frame with each repetition as the body adapts. Eventually, the dose of medication becomes so high the side effects of the medication outweigh its benefits or the medication no longer works. This could also explain the paradox of why continued increasing of a DA causes worsening of RLS symptoms.

This may also explain why weaning off of a dopamine agonist can be torturous. As the weaning process begins dopamine levels drop immediately without the DA. However, GABA levels don’t drop as fast because the body needs more time to adapt. So now we have a double edged sword. We have less dopamine in the body and a very high level of GABA. GABA in now inhibiting an already lowered supply of dopamine making the dopamine even less effective than it should be. Patients are not really weaning off of dopamine but plummeting off of it. That may be why some people claim dopamine agonists are addictive because it feels like they are going through withdrawals.

The concept that opioids inhibit GABA and also release dopamine allows patients to stop taking DA while at the same time keeping GABA in check. Without the need of a DA, dopamine levels can return to “normal” or base line. The key to this concept is the inhibiting of GABA by the opioid to allow the dopamine levels to drop without the torture caused by GABA inhibiting dopamine. As dopamine levels descend GABA levels follow. Over the 1-2 months (varies upon the individual), patients can be weaned off the opioid because the dopamine/GABA levels bottom out eventually putting the patient at base line. The severity of the disease upon each individual dictates the necessity of the dose after the completion of the weaning process.

Bob

[aveerik]

That seems to make a lot of sense. It seems it should be a WED protocol for doctors to try opiates when a patient is stopping a DA. Thanks for the info.