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Thursday, December 12, 2013
Pain & Irritation in Legs, Disrupting Sleep
I am 23 year old working woman. Since last 2 months I have continuous pain in my legs 24 hrs. The pain is very very light when I walk and doing the household. But it aggravates when I sit (give rest to my legs) and when I go to sleep. Sometimes I also feel irritation in my legs while rest or when I go to bed like someone putting needles in my legs. My calves ache all the more then the thighs. Also I can see a little swelling in my calf till the ankle and also on the foot sice a month. 1 month ago I had removed the ectopic pregnancy. The pregnancy was of five weeks when it was removed. Since then the pain had aggravated all the more. Due to this pain I can’t even sleep. Sometime the irritation in the feet and legs is so high that I need to get my bed wet and then only I can sleep. I feel tired all the time. I don’t even feel like doing any work; just want to sleep and sleep and sleep. Tough I take 6-7 hr sleep daily and had healthy food. Don’t know what to do. Please can you suggest something to reduce the pain? Why the pain occurring? And also is the pain is due to the removal of pregnancy?
This sounds very frustrating for you and you are right to seek advice. There are numerous reasons a person may experience these symptoms and you will need a full evaluation to sort out the underlying cause so that appropriate treatment can be recommended. Based on the limited information (and not being able to examine you), I cannot make a diagnosis. However, the portion of your symptoms that relates to the legs getting worse when at rest or when trying to go to sleep could suggest that at least some of the symptoms may be related to restless legs syndrome (RLS), and I can comment on that possibility.
RLS is quite common, affecting roughly 10% of the adult population. The diagnosis of RLS truly rests upon the history with 4 key elements necessary to make a diagnosis. These are as follows: 1) an urge to move the legs, usually associated with an uncomfortable or unpleasant sensation in the legs, 2) the symptoms typically occur at rest, 3) the symptoms typically occur in the evening or at night, and 4) the symptoms are totally or partially relieved with movement, such as walking or stretching. While your symptoms do not fit completely into this pattern, you appear to have at least some of the symptoms and thus RLS must be considered.
The cause of RLS is unknown in most cases, though a search for potential underlying contributors is always worthwhile. Conditions or factors that may be associated with the onset or worsening of RLS include iron deficiency (this can be quite mild and still affect RLS), kidney failure, pregnancy, neuropathy (disease of the nerves), lack of folate or vitamin B12 or magnesium, excessive caffeine ingestion, and certain medications (such as tricyclic antidepressants and selective serotonin reuptake inhibitor antidepressants). If one of these factors is found, particularly one that may be reversible (such as iron deficiency), then addressing this as the initial treatment strategy may be effective and prevent the need for additional medications.
There are a number medications that can be used for the specific treatment of RLS, though at present only some of the dopaminergic agonist agents (roperinole or Requip, and pramipaxole or Mirapex) are FDA approved. Sinemet, another dopaminergic drug, is less effective and not currently FDA approved for RLS. While there is less data to support their use, other non-FDA approved medications commonly used for the treatment of RLS include the antiepileptic medications gabapentin (Neurontin) and carbamazepine (Tegretol), narcotics such as oxycodone (Percocet or Roxicet) and propoxyphene (Darvocet), sedatives such as clonazepam (Klonipin), and antihypertensive medications such as clonidine (Catapres). Each of these medications has its own list of contraindications and side effects.
* Learn important new information concerning the FDA withdrawal of the medication Propoxyphene(Darvon, Darvocet)
Again, based on the limited information, I cannot say whether or not you have RLS. In addition, other more serious disorders need to be considered (such as nerve disorders, muscle disorders, etc.) and you need further evaluation. You should discuss your problems with your primary care physician. Specific factors in your history and examination will be important to getting you relief from your problems. Referral to a Sleep Specialist in your area may also be helpful.
If you would like further information about restless legs syndrome, sleep disorders or sleep itself, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you.
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University