Opiates for Restless Legs

[lobelsteve]

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Study Revolutionize Restless Legs Syndrome Treatment - Neuroscience News

Researchers released new clinical guidelines for treating restless legs syndrome (RLS), emphasizing patient-centered care and evidence-based updates.

neurosciencenews.com

I will gladly refuse all requests to manage these patients when the sleep doc goes to jail.

 

[MitchLevi]

We need a restless legs vaccine

 

[VA Hopeful Dr]

We need a restless legs vaccine

It's called "exercise".

That and the iron supplements the article mentions.

 

[Agast]

I had a few restless legs patients improve when their venous insufficiency was treated, I make all vague leg discomfort get evaluated now

 

[clubdeac]

I have RLS and it sucks!

 

[Ronin1]

I’ve had a few refractory patients on low dose methadone. It works

Long-term Safety, Dose Stability, and Efficacy of Opioids for Patients With Restless Legs Syndrome in the National RLS Opioid Registry - PMC

Restless legs syndrome (RLS) is a sensory-motor neurologic disorder. Low-dose opioids are prescribed for patients with refractory or augmented RLS. The long-term safety, dose stability, and efficacy of these medications for RLS treatment is still ...

pmc.ncbi.nlm.nih.gov

 

[Agast]

I try to avoid starting my patients on regimens that I don’t think another physician will continue if I suddenly dropped dead and all my patients are orphaned

On the other hand, a local doc who did minimal prescribing and had well-to-do patients suddenly vanished and I got a lot of his roster. Very nice 👌

 

[kstarm]

I have had relatively good success with ropinirole and a little surprised they "demoted" it. I never think of opioids for RLS and wouldn't start when usually the lifestyle issues are the biggest hurdle

 

[clubdeac]

I have had relatively good success with ropinirole and a little surprised they "demoted" it. I never think of opioids for RLS and wouldn't start when usually the lifestyle issues are the biggest hurdle

Augmentation is a big problem

 

[Ferrismonk]

That's interesting, however I don't really think of RLS as a pain syndrome. I usually defer these to Neurology, although I guess Sleep Medicine makes sense too.

 

[bedrock]

I’ve had a few refractory patients on low dose methadone. It works

Long-term Safety, Dose Stability, and Efficacy of Opioids for Patients With Restless Legs Syndrome in the National RLS Opioid Registry - PMC

Restless legs syndrome (RLS) is a sensory-motor neurologic disorder. Low-dose opioids are prescribed for patients with refractory or augmented RLS. The long-term safety, dose stability, and efficacy of these medications for RLS treatment is still ...

pmc.ncbi.nlm.nih.gov

I don’t see why you don’t punt these patients to Neurology or sleep.

My focus is on interventional pain. And that is what pays the bills. I’m completely fine if a patient gets better with pt and doesn’t need a procedure. However, I don’t offer COT, or any chronic medication management of any kind. If it appears that medication will be permanent , they should get from their PCP.

I specifically tell patients whenever I prescribe anything that I’ll refill this for 3 months max. If they need it longer, they can get from PCP.

 

[Ronin1]

I’m doing ok financially. I think there is a role for low dose COT for those patients that have failed interventions or not good candidates but I’m not a pain surgeon lol

 

[epidural man]

I don’t see why you don’t punt these patients to Neurology or sleep.

My focus is on interventional pain. And that is what pays the bills. I’m completely fine if a patient gets better with pt and doesn’t need a procedure. However, I don’t offer COT, or any chronic medication management of any kind. If it appears that medication will be permanent , they should get from their PCP.

I specifically tell patients whenever I prescribe anything that I’ll refill this for 3 months max. If they need it longer, they can get from PCP.

We should start calling ourselves the Uncomfortable Clinic.


Tag line -
"We help anyone who is uncomfortable, in any situation!"

 

[Agast]

PCPs tend to think we are the keepers of controlled substances. I get voluntold to prescribe Xanax - hard No. Funny no one expects me to prescribe their Adderall though.

 

[VA Hopeful Dr]

I don’t see why you don’t punt these patients to Neurology or sleep.

My focus is on interventional pain. And that is what pays the bills. I’m completely fine if a patient gets better with pt and doesn’t need a procedure. However, I don’t offer COT, or any chronic medication management of any kind. If it appears that medication will be permanent , they should get from their PCP.

I specifically tell patients whenever I prescribe anything that I’ll refill this for 3 months max. If they need it longer, they can get from PCP.

No thanks. I am not your dumping ground (and I personally don't see pain medicine as my dumping ground either).

Soap box here: if you (generic you) start a patient on a medication that is likely to be chronic you need to own it. This applies to every specialty.

 

[VA Hopeful Dr]

PCPs tend to think we are the keepers of controlled substances. I get voluntold to prescribe Xanax - hard No. Funny no one expects me to prescribe their Adderall though.

Why would anyone expect you to prescribe Xanax? That's not a pain relieving medicine unless we're talking existential pain...

 

[Agast]

Why would anyone expect you to prescribe Xanax? That's not a pain relieving medicine unless we're talking existential pain...

To quote: my doctor doesn’t prescribe controlled substances she told me to ask you

 

[callmeanesthesia]

To quote: my doctor doesn’t prescribe controlled substances she told me to ask you

Sometimes I wonder if they get this stuff from a Reddit thread on how to get narcotics. And I assume when I tell them no they go to their PCP and tell them “The pain doctor said you could do it.”

 

[bedrock]

No thanks. I am not your dumping ground (and I personally don't see pain medicine as my dumping ground either).

Soap box here: if you (generic you) start a patient on a medication that is likely to be chronic you need to own it. This applies to every specialty.

Most of my area PCPs prefer to write their patients chronic meds so the patient don’t have medication interactions.

I’m referring to basic chronic meds, NSAIDS, gabapentin, SSRI/SSNI, cholesterol, HTN, DM, PUD, thyroid, common anticoagulants……but not controlled substances, DMARDS, chemotherapy, advanced psych meds, etc.

 

[geauxg8rs]

Most of my area PCPs prefer to write their patients chronic meds so the patient don’t have medication interactions.

I’m referring to basic chronic meds, NSAIDS, gabapentin, SSRI/SSNI, cholesterol, HTN, DM, PUD, thyroid, common anticoagulants……but not controlled substances, DMARDS, chemotherapy, advanced psych meds, etc.

Thankfully opioids don’t interact with anything

 

[VA Hopeful Dr]

Most of my area PCPs prefer to write their patients chronic meds so the patient don’t have medication interactions.

I’m referring to basic chronic meds, NSAIDS, gabapentin, SSRI/SSNI, cholesterol, HTN, DM, PUD, thyroid, common anticoagulants……but not controlled substances, DMARDS, chemotherapy, advanced psych meds, etc.

Yes and no.

My objection wasn't the meds themselves but your 3 month cut off. I will often take over prescribing from specialists (we all do), but only if someone has been stable of whatever med with no changes for a decent bit of time, a year is ideal.

 

[Orin]

Interesting guideline statement
Lots of conditional statements

I'm surprised at reducing Requip/Mirapex and even Wellbutrin due to augmentation/worsening of symptoms

Augmentation is a big problem

It seemed to be mitigated if iron levels were corrected I thought?

It's a nice example though of how biologic pathways have U shaped dose response curves sometimes where more isn't better

At least they also reduced the usage of benzos

 

[Laryngospasm]

To quote: my doctor doesn’t prescribe controlled substances she told me to ask you

I tell them they have it backwards:. I don’t prescribe go back and ask them..

 

[BobBarker]

I refill an nsaid or whatever indefinitely as long as the patient doesn’t mind coming in every 6 months or so. I also help them out if they are out of BP medications and PCP is not being responsive which also happens routinely. Lots of rural nurse oractione

 

[Ferrismonk]

To quote: my doctor doesn’t prescribe controlled substances she told me to ask you

That is so 2017.