Recent research indicates that pregabalin is also effective for RLS, but the drug does not have FDA approval for this indication. When compared with pramipexole, pregabalin was not associated with impulse-control problems or augmentation. Patients with refractory RLS who have failed multiple agents in the past may respond well to opioids, particularly methadone. Data show that these agents are effective over a decade with little need to increase or discontinue dosing.
“I highly recommend inquiring about your patient’s satisfaction with sleep, even if your patient doesn’t mention it. We should always ask patients about possible difficulties with insomnia, ability to sleep through the night, snoring that wakes them or their bed partners up, an urge to move the legs, and unusual movements at night. Given the bidirectionality between sleep and pain, the treatment of the pain and the underlying sleep symptoms can be very rewarding,” concluded Dr. Avidan.
—Erik Greb