New Guidelines for Safe Use of Opioids for RLS

New guidelines for the safe use of opioids to treat RLS set forth in major medical journal Austin, Texas, Jan. 8, 2018 – At a time of...

New guidelines for the safe use of opioids to treat RLS set forth in major medical journal

Austin, Texas, Jan. 8, 2018 – At a time of heightened national concern about opioid abuse, new guidance is available to help health care providers safely prescribe opioids to treat restless legs syndrome (RLS).

In an article published in the January issue of Mayo Clinic Proceedings , members of the Scientific and Medical Advisory Board of the Restless Legs Syndrome (RLS) Foundation provide a clinical approach for appropriate use of opioids to treat refractory RLS.

“The Appropriate Use of Opioids in the Treatment of Refractory Restless Legs Syndrome,” offers guidance to clinicians on safe and proper prescribing of opioids for RLS, how to assess patients for risk of addiction, and how to monitor opioid use over time.

Restless legs syndrome (RLS) is a chronic neurological disease characterized by an irresistible urge to move the legs, which can severely disrupt sleep. In the US, an estimated 2 to 3 percent of adults need clinical treatment for RLS.

While most RLS patients find initial relief from other medications, these medications often lose their effectiveness over time or cause serious side effects. Opioids, taken in relatively low total daily doses, can offer life-transforming relief for these patients.

“The quality of life of patients with severe RLS is very low. They have intense insomnia; they may have suicidal depression. Physicians should make appropriate use of opioids when other treatment options are ineffective,” says Michael Silber, MB ChB, a neurologist at Mayo Clinic in Rochester, Minnesota (an RLS Quality Care Center), and first author of the article. “We have published this paper so that both specialists and primary care physicians can feel more comfortable prescribing opioids to refractory RLS patients, not feel that they are at risk as physicians in treating these patients, and help relieve their suffering.”

The paper summarizes published clinical trials and case series that have shown opioids to be effective for treating RLS. The authors conclude that risk of addiction is relatively low for people who take opioids for RLS, given that much lower doses are used than for chronic pain conditions.

Recommendations include:

  • Before prescribing opioids, trying strategies to improve response to other medications and considering alternative therapies.
  • Assessing for risk of addiction and educating patients on responsible use. Providers are advised to have patients sign an “opioid contract” agreeing to take precautions such as not sharing the medication with others.
  • Starting with the lowest dose of opioids possible, and monitoring patients over time for effectiveness and safe use.

In this video on the Mayo Clinic Proceedings YouTube channel, Dr. Silber discusses the guidelines.

The RLS Foundation is dedicated to improving the lives of men, women and children who live with restless legs syndrome. Founded in 1992, the Foundation’s goals are to increase awareness, improve treatments and through research, find a cure for RLS. The Foundation serves healthcare providers, researchers, 5,000 members and an estimated seven million individuals in the United States who have RLS. The Foundation has funded more than $1.6 million in RLS research. Learn more at

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