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KMID : 1151920200020040137
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Chronobiology in Medicine
2020 Volume.2 No. 4 p.137 ~ p.140
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Opioid Withdrawal and Restless Legs Syndrome
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Park Eun-Jin
Park Young-Min
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Abstract
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Opioids are widely used for treating pain and severe treatment-resistant restless leg syndrome (RLS). However, reports of opioid withdrawalinduced RLS have recently increased. Various opioids, including fentanyl, oxycodone, tramadol, dextropropoxyphene, and heroin, induce withdrawal RLS, which is an agonizing illness. There are various hypotheses around opioid withdrawal-induced RLS. First, opioids are associated with dopaminergic action in the mesolimbic pathway. The persistent occupancy of opioids in μ-receptors increases dopamine release, but eventually leads to reduced sensitivity or down-regulation of dopamine receptors. The abrupt depletion of dopamine occurs after opioid use cessation, producing RLS. Another explanation is that long-term stimulation of opioid receptors induces the activation of adenylyl cyclase and protein kinase A, which activates tyrosine hydroxylase involved with dopamine synthesis and the reduction of endogenous opiates. Discontinuing opioid use can also lead to the decrement of dopamine synthesis, producing RLS. Additionally, opioid deficiency, regardless of dopamine, is a pathogenesis pathway in opioid withdrawal-induced RLS. No treatment for opioid withdrawal-induced RLS has been established. However, general RLS treatments also apply to opioid withdrawal-induced RLS, including the use of ropinirole, clonazepam, pregabalin, and opioids. Clinicians must be aware of RLS development shortly after the cessation of opioid treatment for pain control/opioid addiction.
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KEYWORD
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Opioids, Restless leg syndrome, Withdrawal symptoms, Fentanyl, Oxycodone, Tramadol
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FullTexts / Linksout information
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Listed journal information
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