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with Michael Breus, PhD, ABSM

This blog has now been retired. We appreciate all of the insights that Dr. Breus has provided to the WebMD community.


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Tuesday, November 30, 2010

Fibro and RLS: The Connection

There are a lot of associations in medicine. If you have X condition, you’re likely to suffer from Y as well. If you’re at risk for A, you’re also at risk for B and probably C as well. Now we have a new connection to consider in my realm: it appears that patients with fibromyalgia have a high prevalence of RLS — restless leg syndrome.

Fibromyalgia is a condition that affects the muscles and soft tissue. It’s considered the most common arthritis-related illness after osteoarthritis, and its hallmark symptoms include chronic pain in the muscles, fatigue, sleep problems, and painful tender points or trigger points at certain parts of the body. It can be difficult to diagnose because there is no single test for the ailment, which is why doctors have to rule out other conditions before diagnosing fibromyalgia.

More than 12 million Americans have fibromyalgia. Most of them are women ranging in age from 25 to 60. Women are 10 times more likely to get this disease than men.

Because of the toll fibromyalgia takes on people physically, it’s no surprise that patients have a harder time getting a good night’s sleep as they endure chronic aches and pain. But the link found between fibro patients and RLS is intriguing. Fibromyalgia and restless legs syndrome share certain features:

  • Women are more likely to suffer from fibromyalgia and RLS
  • There appears to be a genetic component because these conditions run in families.

RLS is equally a mysterious disorder in the sense that we don’t know exactly what causes it and as such, we don’t have a magic bullet for curing it in everyone. Sometimes an iron deficiency can be to blame, for which there is a clear remedy. But many patients with RLS do not fit into a tidy category whereby the direct cause is known. Other problems that are sometimes linked to restless legs syndrome include kidney failure, rheumatoid arthritis, diabetes, nerve damage, anemia, and Parkinson’s disease, but most people who seek treatment do not have any of these other problems. Pregnancy accounts for many RLS cases (and contributes to the gender disparity), and women who get RLS during pregnancy often find that the condition vanishes after giving birth.

The scientists who published the study on this association pointed out that fibromyalgia and RLS share several characteristics. Both conditions can include sensory alterations, the use of antidepressants that can influence the dopamine system, and beneficial effects for exercise. What’s more, an important implication of the study, according to the researchers, is that restless legs syndrome is treatable with drugs that change the dopamine patterns in the brain.  Physicians are urged to ask fibromyalgia patients about symptoms such as leg movements when they are trying to sleep and unpleasant sensations in their legs.

It goes without saying that alleviating these symptoms can enhance a fibromyalgia patient’s experience with sleep and overall quality of life. And it also should be noted that the recommendations for fibro patients are similar to those who seek relief from RLS (or any sleep disorder for that matter). They include:

  • Avoiding tobacco, alcohol, and caffeine.
  • Getting regular exercise.
  • Keeping your bedroom cool, quiet, and comfortable.

The two problems with this study? For one, the researchers determined the presence of RLS among their participants through questionnaires. They weren’t able to factor out people with RLS that can be attributed to medications they were taking at the time. And second, because of the cross-sectional design of the study, the researchers could not ascertain a simple cause-and-effect relationship. Put simply, further research is necessary to clarify a potential causal relationship between the fibromyalgia and restless legs syndrome.

I am however excited to see research in this area linking these two mysterious disorders and I look forward to more research.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 7:35 am

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