The general approach to the treatment of RLS involves eliminating factors that can cause RLS; for example, anti-nausea drugs, antidepressants such as the selective serotonin receptor inhibitors and tricyclics, antihistamines, caffeine, alcohol and nicotine. Patients should have regular sleep and wake times and avoid activities that cause irritation immediately prior to sleep. A brief walk before bedtime can be helpful, as can massage or a hot bath.
Medications for occasional RLS include carbidopa, opioids, dopamine agonists and sedatives. Daily Restless Leg Syndrome can be treated with dopamine agonists, Ropinirole, Pramipexole, Pergolide, opioids, anti-seizure drugs, Clonazepam, to name a few. In those cases where nothing seems to be effective in RLS, some experts have had success with strong opioids such as methadone.
I believe it is very important to screen for RLS in the chronic pain population. We might find something that can be treated, and this in turn may help the pain.
