Guidance for the Use of Opioids in the Treatment of Refractory Restless Leg Syndrome
On January 8, 2018, Mayo Clinic Proceedings published an article on appropriate use of opioids for treating refractory restless legs syndrome (RLS) by members of the Scientific and Medical Advisory Board of the Restless Legs Syndrome Foundation (Mayo Clin Proc. 2018;93:59-67.) The article offers guidance for clinicians on the appropriate use of opioids to treat refractory RLS, including monitoring, addiction risk assessment, and safe prescribing practices.
The incidence of RLS is estimated as 2% to 3% percent of adults, and while most find initial relief from nonopioid medications, these can cause serious side effects and lose efficacy over time. In such cases, opioids given at relatively-low–total-daily doses may offer relief for patients that can significantly improve quality of life.
The paper summarizes clinical trials and case series showing efficacy of opioids for treating RLS, and the authors conclude that risk of addiction is relatively low as doses are much lower than that used for chronic pain conditions. They further recommend trying other medications and alternative therapies before prescribing opioids, assessing all patients for risk of addiction, and educating them on responsible use, as well as starting with the lowest possible dose. In addition, they suggest having patients sign an “opioid contract,” agreeing not to share opioid medications with others and to having their physician monitor their opioid use over time.
Lead article author Michael Silber MB, ChB said, “The quality of life of patients with severe RLS is very low. They have intense insomnia; they may have suicidal depression. Physicians should make appropriate use of opioids when other treatment options are ineffective. We have published this paper so that both specialists and primary care physicians can feel more comfortable prescribing opioids to RLS patients, not feel that they are at risk as physicians in treating these patients, and help relieve their suffering.”