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Can Cannabis Help Restless Legs Syndrome?

by Emily Earlenbaugh, PhD.

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Overview

Cannabis can potentially help treat different types of movement disorders, including restless leg syndrome (RLS). However, the actual scientific research is scarce on the topic. There is some very limited clinical evidence that cannabis has helped some with RLS but the data is so limited that is impossible to draw strong conclusions. Still, research on how cannabis impacts movement and other movement disorders suggests that it does have the potential to help. 

While the cause of RLS remains mysterious, researchers believe it has something to do with a dopamine imbalance in the brain. Since both THC and CBD directly interact with the dopamine system, and help regulate movement, cannabinoids could potentially help treat RLS.

How Cannabis Works on RLS

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.

When it comes to RLS and movement disorders, one reason researchers believe that cannabis can help is because of how connected these disorders are to the ECS. 

For one thing, we see a lot of cannabinoid receptors in the basal ganglia – the main part of the brain associated with movement. Certain movement disorders (such as dyskinesias) are actually even associated with impairments in these cannabinoid receptors. 

In addition, movement disorders such as RLS involve dopamine, and treatment is often drugs that increase dopamine. Endocannabinoids have the ability to affect dopamine levels (an important aspect of RLS).  For example, THC (one of cannabis’ most common chemicals) can increase dopamine levels and its long term use can lead to lower levels of dopamine as your system adjusts to the extra stimulation from THC. 

Taken together, this evidence provides a compelling case that cannabinoids may be able to help with movement disorders like RLS. But we need to look to the medical studies to find out whether this is really the case in humans.

Medical Studies on RLS and Cannabis

Unfortunately, when it comes to medical studies on using cannabis for RLS, the evidence is extremely scarce. In fact, there have been no rigorous clinical studies on using cannabis for RLS, at all. The only study looking at this potential use for cannabis was a single case series describing six patients who were able to successfully use cannabis for their RLS symptoms. 

In this study from 2017, the researchers reported that all six patients were diagnosed with severe RLS and weren’t able to find any traditional treatments that could help without intolerable side effects. All six tried using cannabis, and all six reported a remarkable and total remission of RLS symptoms following the cannabis use.

This incredible account of complete remission of RLS symptoms provides hope that cannabis can help with RLS, and motivation to keep researching further. Still, the conclusions we can draw from it is limited since it is just one small study.

Still, the lack of direct evidence doesn’t mean that cannabis can’t help with RLS, just that more rigorous research is needed. Unfortunately, governmental restrictions on cannabis research make it very difficult to do rigorous studies on human subjects. So while cannabis shows promise as a treatment for many conditions (like RLS), in many cases we simply lack the type of research needed to make conclusions about its efficacy in one direction or the other.

CBD for Restless Leg Syndrome

In addition, CBD, a medicinal chemical in cannabis which can also be produced from hemp, has also shown potential for helping with movement disorders such as PD and HD. In some studies it was able to help symptoms related to dystonia and REM sleep behavior disorder — but in rare cases seemed to increase tremors in some patients. This only seems to add to the confused state of the research on this topic. 

Clearly more research is needed on RLS and other movement disorders, to learn exactly how and when cannabis can help.

Side effects 

When it comes to side effects from using cannabis for movement disorders, they are usually mild and tolerable when compared to other medications, and include nausea, impaired short-term memory, cognitive impairment, dry mouth, hallucinations, dizziness, fatigue, behavioral or mood changes, impaired motor skills, and increased weakness, heart rate and appetite. 

Cannabis Side Effects

In the case study that reported cannabis’ helpful role for RLS, one person reported nausea — but continued to use cannabis when RLS symptoms were severe. 

Some point to worries about the risk of psychopathologic effects from cannabis, such as increased risk of schizophrenia — which studies say affect around 1% of those who use cannabis. But it should be noted that an estimated 20.7% with RLS develop psychopathologic impulse control disorders while taking the usually prescribed medications for RLS.

Disclaimer

The Cannigma content is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with an experienced medical professional with a background in cannabis before beginning treatment.

About Restless Legs Syndrome

Overview

Restless Legs Syndrome (RLS), also called Willis-Ekbom disease, is a neurological disorder that makes people feel an uncomfortable feeling in their legs or other parts of their body, which creates an irresistible urge to move them. After moving their legs, the discomfort disappears for a while. 

RLS can affect anyone at any age, although it is more common in women than in men, and appears more often during middle age. It generally gets worse as you get older. While many people have never heard of this condition, it is incredibly common. It’s thought that 7-10% of adults worldwide have RLS, although it often goes undiagnosed so the rate could be much higher.

More than 80% of people who have RLS also have PLMS, or periodic limb movement of sleep. This means that their legs, and sometimes their arms too, jerk or twitch involuntarily during sleep. While closely correlated and associated with each other, people may have one condition or the other exclusively.

The symptoms of RLS are felt most strongly at night, although people can also feel them when they’ve been sitting or lying without moving for a long period of time. Given that it happens often before sleep, it can interfere with and harm regular sleep patterns.

RLS is not a life-threatening disorder, but because it frequently interferes with sleep, it can have a significant impact on daily life. People with RLS often find the lack of sleep leads to poor function and fatigue during the day. It makes it hard for them to concentrate at school or at work, affects their mood, and can impact their personal relationships. It is estimated that RLS is responsible for an average decrease in productivity of 20%, and contributes to cases of depression and anxiety. 

Many people with restless legs syndrome never visit their doctor about it, because they think it’s not important or worry that they won’t be taken seriously. However, RLS is a real condition that can be treated successfully with medication and lifestyle changes.

Symptoms

The main symptom of restless leg syndrome is the one that gives it its name: feeling an overwhelming need to move your legs. This urge to move your legs frequently comes with strange and uncomfortable sensations, like feeling the legs aching, pulling, or itching, or feeling like something is crawling or creeping along them. Sufferers of RLS may each feel these symptoms slightly differently. 

At times, these sensations might just feel uncomfortable or annoying for some, but for others they can be quite painful. Most people with RLS feel it only in their legs, although sometimes arms and very rarely the head and chest can be affected too. It generally affects both legs, but can be felt in just one leg, or alternate between both legs. 

Most people with RLS find that keeping their legs moving temporarily relieves the pain or discomfort, so they’ll typically pace up and down, jiggle their legs, or keep tossing and turning when in bed. Generally the feelings are worse in the evening and at night, but decrease in the early morning. This makes it hard for people to get to sleep or stay asleep at night. 

People with RLS might not experience symptoms every day. They could occur only once or twice a week, or more often, and with varying severity. Sometimes RLS goes into remission, which means that people can enjoy months or years without any symptoms. For most people, RLS gets worse as they get older, but for someone who develops the symptoms at a very young age, they might only get worse very very slowly. 

Complications

Because it’s hard for people with RLS to get enough sleep, it can cause lack of focus and mental health disorders. The poor sleep often leads to depression and anxiety, excessive drowsiness, and poor productivity. 

Diagnosis

It’s difficult to diagnose restless legs syndrome, because there’s no test to prove or disprove it. In fact, RLS is often misdiagnosed as depression, which is brought on by the lack of sleep caused by restless legs, but the person doesn’t think to mention their RLS symptoms, and/or the doctor doesn’t have enough experience to recognize the condition. 

Diagnosing restless legs syndrome depends on your doctor taking a thorough medical history, asking you about your symptoms and sleep habits, and carrying out a full physical examination. Your doctor will usually order blood tests to help rule out other causes like iron deficiency anemia or kidney failure, and possibly request a sleep study to check for sleep apnea or another sleep disorder.

There are four main criteria that the doctor will look for in diagnosing RLS:

  • A strong, overpowering need to move your legs, together with an uncomfortable itching or tingling sensation
  • The need to move your legs begins or gets worse when resting
  • The symptoms are partially or totally relieved by moving your legs
  • The symptoms begin or get worse in the evening or at night

Diagnosing RLS is even more difficult in children, because they can find it hard to describe their symptoms accurately. It’s often dismissed as “growing pains” or as a type of ADHD

Causes

Most of the time, there’s no known cause for RLS. This type of RLS is called primary or idiopathic RLS. Possible causes for RLS are:

  • Imbalance in the dopamine pathways. Scientists think that primary RLS might be caused by an imbalance in the brain’s production of dopamine, which controls smooth muscle movement. People who have Parkinson’s disease are at greater risk of developing RLS, and it’s known that Parkinson’s is a disorder of the dopamine pathways. 
  • Genetics. It’s also thought that there’s a genetic element to RLS. In families with a tendency to RLS, the symptoms always begin before the age of 40. 
  • Iron. It’s also possible that a lack of iron contributes to RLS symptoms. 

Certain underlying health conditions and other factors can raise your risk of getting RLS, including:

  • End-stage kidney disease and hemodialysis
  • Peripheral neuropathy, which can be due to alcoholism, diabetes, or chronic disease
  • Spinal cord conditions, including lesions on the spinal cord, or having a spinal block
  • Some medications, like anti-nausea drugs, antipsychotics, antidepressants and some cold or allergy medications
  • Taking alcohol, nicotine, and coffee
  • Being pregnant, especially during the last trimester

Many people find that symptoms get worse when they are sleep-deprived, which can lead to a vicious circle of RLS leading to poor sleep, which in turn worsens the symptoms and disturbs sleep even more.

Treatment

Treatment for restless legs syndrome generally focuses on a combination of medication and lifestyle changes. Sometimes, treating the underlying cause of RLS can make the symptoms go away, like correcting an iron deficiency or neuropathy.

Medication 

There’s no single drug that cures RLS. People with RLS usually need to take a combination of different medications, usually using a process of trial and error to find the ones that are the most effective. What’s more, medication can sometimes stop having an effect when it’s taken for a long period of time, which means people with RLS may have to change prescriptions.

Medications that help relieve RLS include:

    • Neuropathic agents. Gabapentin (Neurontin), and pregabalin (Lyrica) are the drugs of choice for treating RLS. They lower sensory disturbances like creeping and crawling sensations. However, side effects include fatigue and weight gain.
    • Dopamine agonists. These drugs increase levels of dopamine in the body. They are mostly used to treat Parkinson’s disease, but they can also help with the symptoms of RLS when taken at night. Examples include Ropinirole (Requip) and Pramipexole. Side effects may include sleepiness, nausea and stomach upset, and hallucinations. 
    • Opioids. Medications like codeine, hydrocodone, methadone, and oxycodone are sometimes prescribed for more severe symptoms of RLS that don’t respond to other treatments. Opiates however can lead to somnolence, overuse and addiction.
    • Benzodiazepines. These can help people with RLS to enjoy more restful sleep, but they can aggravate sleep apnea. 
    • Iron supplementation. Sometimes iron supplementation can help alleviate the symptoms of RLS, but they often cause constipation.

 

 

Lifestyle changes

Some people with RLS find that lifestyle changes can help relieve their symptoms. These include:

  • Reducing alcohol and caffeine consumption
  • Keeping to a regular sleep pattern
  • Getting moderate exercise every day
  • Leg massage
  • Quitting smoking
  • Heat and cold therapy, like having a warm bath or applying an ice pack

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