If a patient presents with rheumatoid arthritis or fibromyalgia, the physician should screen the patient for restless legs syndrome. First-line therapies are dopamine agonists, including Neupro Patch, Requip, Mirapex. Next class is based on gabapentin-type medications. Lyrica is in that class. It is effective but it does not have FDA approval for this indication. Unlike dopamine agonists, Lyrica was not associated with impulse control problems or augmentation.
According to Dr Alon Avidan, physicians should always ask patients about difficulties with insomnia, snoring, an urge to move the legs, or unusual movements at night. Because sleep and pain are bidirectional, the treatment of the pain and the underlying sleep symptoms can be very rewarding. This was presented at the 66th Annual Meeting of the American Academy of Neurology.
Dr. Jack Florin
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