Oh Those Aching Legs

by:  Susan Klick, MSN, RN, CNL

You are tired, you want to go to sleep, but your legs aren’t cooperating. You have an irresistible urge to move your legs, maybe even your thighs or your arms.  Or maybe you are at the movies, and your legs feel “jumpy”.  Long trips in the car, or a long-distance flight give you a throbbing, pulling, or creeping feeling in your legs.  This is Restless Leg Syndrome (RLS) and it can make bedtime or long car trips a nightmare.

Many times, RLS is confused or misdiagnosed as Peripheral Neuropathy. Diabetic neuropathy in particular is a nerve disorder caused by poor blood sugar control in people with diabetes.  The most common type of peripheral neuropathy results in problems with the feet.  Symptoms include numbness, pain, or tingling in the feet or lower legs and may be associated with difficulty in walking and weakness in foot muscles.

How do you know what you are dealing with? The most important questions to ask yourself are:  1) when does the pain occur and 2) does movement make the pain go away or feel better.  If the symptoms occur when you are lying down and trying to relax, in the evening, and movement makes the pain better, then you are most likely dealing with RLS.  RLS is sometimes seen in patients with kidney disease, Parkinson’s disease, people with low iron, pregnancy, and those taking antidepressants or antipsychotic drugs.  However, if you are experiencing numbness, tingling, and pricking sensations, sensitivity to touch, muscle weakness, burning pain that is not eased by walking (movement may even make the pain worse), and symptoms which do not change during particular times of the day –  you may be dealing with Peripheral Neuropathy.  What can make a diagnosis difficult is that the two can occur together.

By definition, RLS is a neurological disorder with symptoms occurring when lying down or trying to relax (primarily at night), and relief is found in moving the legs. Peripheral Neuropathy describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body.  It can be either inherited or acquired (as is the case with Diabetic neuropathy).

The key to managing peripheral neuropathy is to recognize the symptoms and work with your doctor to find the right treatment and approach that works for you.

  1. Keep your blood glucose levels in check. This can prevent or delay nerve damage or prevent further damage.
  2. Mild symptoms can be relieved with over the counter, nonsteroidal anti-inflammatory medications.
  3. Medications to treat epilepsy, such as gabapentin and pregabalin, may help control more serious symptoms.
  4. Some physicians may recommend a tricyclic antidepressant, such as amitriptyline or doxepin, in a modest dose, to alleviate pain. Studies show that newer antidepressants may ease discomfort

If you have a distinct “creepy crawly” sensation, consult your doctor. Treatment for RLS may include having your blood checked for levels of vitamin D and iron.  Correcting deficiencies of each helps some people control symptoms.  Reducing the use of caffeine, alcohol, and tobacco can also make a difference.  The treatment of choice are drugs known as dopaminergics, which increase the body’s dopamine and have shown to alleviate moderate to severe RLS.





Source: Diabetes Living Fall 2015; Clinical Advisor March 2015; NIH.Gov

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