Opioid Withdrawal and Restless Legs

The first time I heard of “restless legs” was during a TV commercial for medicine and I giggled because it seemed like a silly name.  I thought something so silly didn’t really need a special medication.   What in the world is restless leg syndrome, anyway?!?  All I can say is that if it happens to you, you’ll immediately know “THIS is restless legs.”  I know because I ended up getting restless legs later in life from opiate withdrawal……  turns out it isn’t silly at all.  Also, it can be downright awful.

What is Restless Leg Syndrome?

Restless leg syndrome (RLS) is basically a strange sensation you get in your legs.  It’s an overwhelming urge to keep your legs moving.  But it’s not a pain, or an itch, or a tickle or anything physical that you can really describe.  You just have to move your legs.  Nothing bad is going to happen, but nonetheless, you just can’t sit still.  You can get varying degrees of restless legs, so if it’s not too bad you might just toss and turn or keep bouncing your knee in your chair.  If it’s bad though, sitting or laying down isn’t an option and sufferers might just pace back and forth for hours without stopping. The first time I got RLS I thought maybe I was having a mild panic attack because I just couldn’t sit down.  It was so weird.  After a couple of instances of similar symptoms, I realized it was only my legs feeling funny.  I once heard a girl say she’d get “ants in her legs” and I thought that was a pretty good description.  I’ve also seen it described online as a “pulling,” “throbbing,” and “fizzy legs,” which I also like.  You can also get restless arms and the internet says you can get restless torso.  I remember once I felt like my clothes were constricting me and I kept pulling at them (while also pacing, of course), and I imagine that’s probably what they mean by restless torso. Also, it’s awful.

RLS aka Willis-Ekbom Disease

RLS is also known as Willis-Ekbom Disease and is classified as a neurological disorder.  The exact criteria for clinical diagnosis of RLS is the following:
  • an urge to move the legs, usually accompanied by an uncomfortable sensation
  • the uncomfortable sensation begins or worsens during periods of rest (sitting or laying down)
  • the unpleasant sensations are partially or totally relieved by moving 
  • the urge to move is greater in the evening or night than during the day
Some experts believe up to 15% of the US suffers from at least mild restless legs.  It’s more common in pregnant women and people with end stage renal disease (kidney failure).

What Causes Restless Legs?

The medical community isn’t entirely sure what causes restless legs. Therefore, there isn’t much information on the topic.  They know it’s a nerve sensation and that it probably starts up in the brain, not the legs.  They’ve also figured out that there’s a genetic component to it and therefore it runs in families.  In addition, it definitely has to do with the dopamine system in the brain.  Dopamine is a neurotransmitter that affects emotions and movement.  There’s also a correlation between people with RLS and low selenium levels, which makes some sense since selenium affects dopamine.  Finally, there’s good evidence that RLS is correlated with iron deficiency.

Restless Legs When You’re in Opiate Withdrawal

So while I don’t see any mention of it in medical literature online, we also know there’s a direct link between restless legs and opiate detox.  (By “we” I mean people who have ever had withdrawals from opiates.)  It doesn’t seem to happen to everyone but it does happen to a good proportion of people as they withdraw from opiates like heroin, fentanyl, and painkillers.  I’ve never heard of it happening from buprenorphine (Suboxone, Subutex) but feel free to comment below if you know differently. The thing is, opiates have huge affects on dopamine levels in your brain.  Using opiates makes dopamine levels increase.  That’s what causes the “happy” feeling and gets rid of the anxiety when you use.  As your brain comes down off the drugs though, the dopamine levels go down.  That’s when you start to feel sick and sad and anxious.  Doctors already know that restless legs are related to a lack of dopamine.  So it makes sense that as dopamine levels drop after drug use, the restless legs start up.   Because the drugs are pushing dopamine levels in our brain higher than they would go naturally, we’re seeing physical affects in the body that we didn’t see naturally.  In fact, there are some prescribed medicines that also greatly increase dopamine (called dopaminergic drugs) and a known withdrawal symptom from those medicine is severe RLS.  Medical literature states that the worst of the RLS from withdrawal should go away after two days, and that after a week, things should be back to normal.  But that’s assuming you stop using drugs and enter drug rehab.

How to Stop Restless Legs When You’re Coming off Drugs

Just like people who suffer from restless legs on a daily basis, there’s hope for those of us who get restless legs from withdrawal.  Thankfully, there are home remedies for restless legs from opiate withdrawals.  There are also some medically recognized solutions.  I’ll go over all of it.   First of all, the best, most obvious answer is to stop abusing opiates so that dopamine levels in your body regulate.  But I know that’s not the answer that’s going to help in the moment you’re suffering from RLS from withdrawal. Okay, so as you may know, the restless legs will also stop if you use opiate drugs again.  (This solution is very dangerous and IS NOT officially recommended by this blog!)  Actually, doctors will prescribe low doses of opiate based painkillers if people with severe RLS don’t respond to other treatments.  So opiates ARE recognized for their ability to stop RLS.  But this is just one solution.  There are many others available to help RLS when you have withdrawal symptoms.

Other medicines that are often prescribed to treat RLS

Horizant (Gabapentin Enacarbil).  This first line RLS treatment is a prodrug of the more common gabapentin (Neurontin).  Prodrug means that after you take it, your body turns it into the other drug. Gabapentin (Neurontin). RLS treatment isn’t an official use of gabapentin but it is often given a try for RLS. Buproprion (Wellbutrin).  Helps RLS in the short term.  This is an antidepressant that stops dopamine from getting absorbed back into an inactive state in the brain.  It would probably have little effect in the withdrawal situation since brain dopamine levels of an opiate abuser are depleted so it doesn’t have much to work with. Pregabalin (Lyrica).  This is a non-opiate painkiller similar to gabapentin.  Use with caution because you can get physically dependent on this drug and end up with a whole different set of withdrawal problems. Clonidine (Catapres).  This is actually a blood pressure drug that’s often used to help opiate withdrawals.  there’s evidence that it lessens the severity of RLS for some people.  Doctors are usually open to prescribing this relatively harmless medicine for withdrawals so it’s worth asking about. Benzodiazepines (Xanax, Klonopin, Librium, etc).  I really don’t suggest taking benzos as they are addictive and have their own awful withdrawal effects, but they are often used to treat RLS.  I mention them because sometimes a medical detox facility opts to use a benzo for opiate detox rather than bupeprenorphine.  A commonly used combination is librium and clonidine.  If this is what a doctor is proposing to you, you can give it a try and know that both can help with RLS.

Non-Prescription Medicines and Home Remedies for RLS

Over the counter painkillers. Tylenol, Motrin, etc (but not aspirin) sometimes help lessen symptoms.  Naproxen (aka Naproxen Sodium or Aleve) would be a good choice since it lasts longer than the other ones.  Take as directed – OD of these meds can hurt your stomach or liver. Iron supplements. Usually these are called “ferrous sulfate.”  But even just a multivitamin with extra iron might help.  Anemia (iron deficiency) is a risk factor for RLS so getting your iron levels up to normal can make a difference.  There’s some evidence that iron helps RLS even if someone isn’t deficient in iron.  Don’t take too many of these either, or bad things can happen. B Vitamins.  Particularly B6, B9, & B12.  These are also called pyridoxine, folate (or folic acid) and cobalamin.  These help a lot with anemia and iron production.  You can get all three in a vitamin called “B-complex.”  They also come in some multivitamins. Cashews or Almonds.  Sorta random but these two nuts contain high levels of selenium and magnesium.  Both of these supplements have been shown in separate studies to lessen RLS symptoms.  Coincidentally, a lot of people don’t get enough of these minerals, so there’s a good chance you’re deficient and will feel better if you replenish your body. CBD/Marijuana.  Anecdotal evidence exists that some people get ease from RLS when they consume weed or even just use some CBD.  The method of taking the weed or CBD didn’t seem to matter.  However, many opiate users suffer terrible anxiety from marijuana, so if you haven’t done marijuana in a while, this isn’t the best option for RLS from opiate withdrawals.

These Things Make Restless Legs Worse

Alcohol.  It makes RLS worse.  Plus it’s bad for you. It doesn’t really help with opiate withdrawal – it just makes it more dangerous. Sleep medicine.  The non prescription ones, specifically.  Many over the counter sleep meds use either dimenhydrinate or diphenhydramine.  These make RLS worse. Benadryl and Dramamine.  These are brand names of the two products mentioned above.  Note – sometimes these are used as cut in white powder heroin.  You may be taking them without meaning to and they are aggravating your RLS symptoms.  A medical detox using suboxone would be a safer and more comfortable way to make sure you know what you’re ingesting.

Other Tricks to Try for RLS

In addition to medication, there are a few other things you can try to help treat restless legs at home.  These are home remedies that I know of, mostly from my own experience and talking to other people who’ve experienced RLS brought on by opiate or heroin withdrawal.  Whether or not they work varies from person to person.  Also, sometimes your RLS is so bad that not much will help.  But if you can wait it out a few hours, sometimes symptoms will decrease to a moderate level so that some of these tricks help.
Temperature Changes
Hot baths. Or even a shower if you don’t have a bath tub.  This also helps with the chills, sweating, and bone aches of withdrawal so it’s always one of my first suggestions.  I personally would fall asleep in a hot bath when I was dope sick. –Cold wrap.  Try setting or wrapping a damp cold towel on your legs.  You can keep a damp towel in the refrigerator so there’s one available anytime you need it.

A bathtub can help with withdrawal symptoms from opiatesYour new best friend.

Compression
Swaddling your legs or body (wrapping them tightly, like you would a baby).  You can use a sheet or blanket or even ace bandages.  Some people will use “compression socks” on their legs which you can buy in a pharmacy. Put weight on your limbs.  Lay on your stomach with your arms under your chest for restless arms or try putting a heavy pillow on your legs.  Or try a weighted blanket, which also helps with anxiety.
Get Moving
-Exercise.  Getting moderate exercise can be a big help.  You can try exercising during the day before RLS sets in if you know you’ll have problems later.  Or just going for a walk or jog even if you feel sick can calm your body.  You don’t need to overdo it though, because exercising until you’re sore can make RLS worse. -Stretching.  You don’t have to hold a stretch long for it to help relax muscles.  A lot of people find relief from stretching or yoga. -Tap your foot.  Sometimes tapping your foot or wiggling your toes will be enough movement for your legs.  Those are things you can do laying down in bed or sitting down.  That will help the rest of your body get some rest.  You can find the right beat and then just keep tapping your foot to that beat.  Sometimes that rhythm will help people drift off to sleep without even realizing it.
Get a vibrating pad.  So these are generally sold as heat pads to treat aches and pains.  But there’s a fancy FDA approved vibrating pad that doctors can prescribe for RLS that’s proven to help increase sleep.  You put it under your legs and the vibration helps the weird sensations.  The heat pad version isn’t the same thing, but might help anyway.  They’re generally $30-$50. (The prescription one is like $1000.) RLS can easily be helped with home remedies

Confused? I am too. There must be $800 worth of magic in there.

Self-Care
Drink water.  This is important during opiate withdrawals.  The sweating, diarrhea, and vomiting of withdrawal can quickly dehydrate someone.  In fact, dehydration is the biggest risk of complications from opiate withdrawals.  It’s possible to die or permanently damage your kidneys from dehydration.  So sip on water or gatorade or even Pedialyte during withdrawals.  Even mild dehydration will cause cramping and headaches, and can throw off your electrolytes, which means the sodium and potassium in your body.   You need your sodium and potassium balanced to help your cells function properly.  This means your heart, your brain, and your nerves that affect RLS. –Get some sun.  People with a Vitamin D deficiency seem to experience worse RLS symptoms.  Vitamin D is made by your skin when it gets some sunlight.  So try to get outside for a little bit every day so you get enough Vitamin D.

Are You Ready to Get Clean?

I know we covered a lot just now, but hopefully you understand why opiod withdrawal causes restless legs and some things you can do to help the symptoms.  To me, restless legs is just the worst.  I found it to be mentally infuriating and hopelessly uncomfortable.  But opiate withdrawal is pretty miserable in general, and the truth is that the misery will keep happening until you stop abusing opiates once and for all.  If you ever want to find out what your options are for medical detox & treatment, you can always contact us at Never Alone Recovery.  In the meantime, let us know if you know of other home remedies for RLS or if you have any other questions we can answer!

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References:

Burbank F, M Buchfuhrer, B Kopjar.  Sleep improvement for restless legs syndrome patients. Part 1: pooled analysis of two prospective, double-blind, sham-controlled, multi-center, randomized clinical studies of the effects of vibrating pads on RLS symptoms.  Journal of Parkinsonism and Restless Leg Syndrome. 2013 March 28. 2013:3 1–10. http://dx.doi.org/10.2147/JPRLS.S40354  Hornyak M1, Voderholzer U, Hohagen F, Berger M, Riemann D. Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study. Sleep. 1998 Aug 1;21(5):501-5. DOI: 10.1093/sleep/21.5.501. https://www.ncbi.nlm.nih.gov/pubmed/9703590 Kalloo, Aadi, Charlene E Gamaldo, Anthony B Kwan, Rachel E Salas. THE IMPACT OF RESTLESS LEGS SYNDROME/ WILLIS–EKBOM DISORDER ON QUALITY OF LIFE. European Neurological Review, 2013;8(2):97–104 DOI: http://doi.org/10.17925/ENR.2013.08.02.97 Liptan MD, Ginerva.  Natural Treatments for Restless Legs Syndrome.  2018 October 31.  http://www.drliptan.com/blog/2018/10/30/natural-treatments-for-restless-legs-syndrome Mitchell, U. (2015). Medical devices for restless legs syndrome – clinical utility of the Relaxis pad. Therapeutics and Clinical Risk Management, 1789-1793. doi:10.2147/tcrm.s87208. https://www.researchgate.net/publication/285627505_Medical_devices_for_restless_legs_syndrome_-_Clinical_utility_of_the_Relaxis_pad National Institutes of Health.  NIH News in Health.  Can’t Curb the Urge to Move? Living with Restless Legs Syndrome. (2012 October).  https://newsinhealth.nih.gov/2012/10/cant-curb-urge-move Restless Leg Syndrome Foundation. Understanding RLS. https://www.rls.org/understanding-rls Smith M, MA, Robinson L, Segal R, MA.  Restless Legs Syndrome (RLS).  HelpGuide.org. 2019 June. https://www.helpguide.org/articles/sleep/restless-leg-syndrome-rls.htm/ Ulfberg J, Stehlik R, Mitchell U. Treatment of restless legs syndrome/Willis-Ekbom disease with selenium. Iran J Neurology 2016; 15(4): 235-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392199/ Walters AS, Ondo WG, Kushida CA, Becker PM, Ellenbogen AL, Canafax DM, Barrett RW. Gabapentin enacarbil in restless legs syndrome: a phase 2b, 2-week, randomized, double-blind, placebo-controlled trial. Clinical Neuropharmacology. 2009 Nov-Dec;32(6):311-20. doi: 10.1097/WNF.0b013e3181b3ab16. https://www.ncbi.nlm.nih.gov/pubmed/19667976