Why does withdrawal cause rls

Shivering, shaking, chills, and goosebumps, are common. One peculiar symptom of this phase is dilated pupils. As the body detoxes from opiates, the pupils compensate by becoming heavily dilated. Lastly, is the post acute withdrawal phase which can be short term or long term. Post acute withdrawal syndrome is the reappearance of withdrawal symptoms within the first 18 months of sobriety from opiates. This post acute phase, however, can last up to a few months. Opioids modulate the dopamine system via their receptors and change the sensitivity to dopamine.

Abrupt withdrawal of opioid may cause an endogenous opioid deficit state and disturb the dopamine system, which can lead to a transient dopamine dysfunctional state such as RLS. We reported a man with secondary RLS after acute withdrawal of the opioid, oxycodone, which has not been previously reported. Key words : Secondary restless leg syndrome , Oxycodone , Opioid , Dopamine. Brief Communication. Published online: Dec 1, Abstract Restless leg syndrome RLS can develop secondary to various medical conditions.

Alteration in nigral iron deposition and dysfunction of dopaminergic modulation is generally thought to be the main underlying pathophysiology of RLS. Oxycodone, a semisynthetic opioid, is one of the treatment options for severe RLS. There are some reports that abrupt withdrawal of some opioids can induce RLS.

Therefore, abrupt withdrawal of oxycodone is expected to induce RLS. However, RLS has never been reported as a withdrawal symptom of oxycodone. We reported a case of secondary RLS, which developed after abrupt withdrawal of oxycodone in a patient with hepatocellular carcinoma associated with severe abdominal pain.

Lipidolol and gelfoam embolization was done at the right hepatic artery, but he still suffered from severe abdominal pain. One week later, he developed an uncomfortable and tickling sensation on the entire body, which was particularly severe on both legs at night.

This uncomfortable sensation started in the evening and gradually worsened until midnight. The symptoms were aggravated especially at rest and could be relieved only on moving or massaging his legs. Consequently, he suffered from severe insomnia and visited the Department of Neurology. Long-term follow-up on restless legs syndrome patients treated with opioids.

Mov Disord ;— The role of opioids in restless legs syndrome: an [11C]diprenorphine PET study. Brain ;— Does the endogenous opiate system play a role in the Restless Legs Syndrome? A pilot post-mortem study. J Neurol Sci ;— A role for hippocampal opioids in long-term functional plasticity. Trends Neurosci ;— Opposite effects of mu and kappa opiates on the firing-rate of dopamine cells in the substantia nigra of the rat.

Eur J Pharmacol ;— Continuous co-administration of dextromethorphan or MK with morphine: attenuation of morphine dependence and naloxone-reversible attenuation of morphine tolerance. Pain ;— High doses of dextromethorphan, an NMDA antagonist, produce effects similar to classic hallucinogens. Jensen JB. Dependence after treatment with tramadol. Ugeskr Laeger ; Miranda HF, Pinardi G. Antinociception, tolerance, and physical dependence comparison between morphine and tramadol.

There are case reports of transient RLS in opiate withdrawal. However, their RLS persisted even after the remission of other withdrawal symptoms. Thyroid function test, hemogram, serum ferritin were normal in all of them. The cases responded well to a treatment with ropinirole. Hence, there might be a causal association, which required further well-designed studies to substantiate. The sleep disturbances and use of benzodiazepines can be minimized by increasing clinician's sensitivity to diagnose RLS.

Opioid dependence is currently seen as a biopsychosocial disorder. Opioids can induce long-lasting alterations in the nervous system. On the other hand, restless legs syndrome RLS is a sensorimotor disorder affecting sleep. RLS is a clinical diagnosis and is based on the following four essential criteria from the patient's history as per National Institute of Health criteria :[ 1 ]. An urge to move the legs, usually accompanied by uncomfortable and unpleasant leg sensations. Transient restless leg syndrome as a complication of opiate withdrawal is known from case report and case series.

This case report would describe three such cases. However, he continued DPP in dependent pattern for last 4 months. A year-old male patient with no significant past and family history was dependent to opioid DPP for last 4 years. He had four episodes of generalized seizure once in withdrawal and others during intoxication. In addition, he started abusing steroid dexamethasone for last 6 months and developed exogenous Cushing's disease, which was followed by acute Addison's disease due to abrupt stoppage of steroid.

For which steroid supplementation was given. A year-old male with no significant family history and past history of trichotillomania was dependent to opioid DPP and codeine containing cough syrup for last 12 years.