Restless Legs Syndrome - RLS and Fibromyalgia

It is not pain that makes the legs restless. People with fibromyalgia hurt all over, including in the legs, so of course they cannot keep still in the evening. That objection comes early, and it deserves to be taken seriously. It has also been refuted. In a synthesis of 17 studies, restless legs syndrome was found in 38.1 per cent of people with fibromyalgia and in 4.4 per cent of people with osteoarthritis. Both conditions hurt, both affect the legs, both are worse at night. Only one goes with restless legs. The difference lies not in the intensity of pain but in the manner in which pain is processed. This volume first shows how the urge to move and constant pain can be told apart in practice. The key question is not whether it hurts but whether you have to get up. Six questions, derived from the findings of the book, help to sort out which is which. In the only controlled study, 33.0 per cent of people with fibromyalgia had restless legs, against 3.1 per cent of pain- and fatigue-free controls. Those with both slept markedly worse, yet their leg pain did not differ. It then follows up the shared ground. In restless legs syndrome sensitivity to pinprick stimuli is increased three- to fourfold, and it fell by 60 per cent under dopaminergic treatment. The body’s own pain brake grips more weakly: 69 per cent of the pain response remained, against 52.5 per cent in healthy controls. Fibromyalgia is defined by exactly this kind of disordered pain processing. Sleep links the two, and iron status is the one explanation that can be both measured and treated. The treatment section is the practical yield. One group of medicines acts on both conditions, and the book explains why the time of day at which it is taken matters. Two of the commonest fibromyalgia medicines, by contrast, belong to substance groups for which triggering or worsening of restless legs has been described. Knowing that can save months of trying in the wrong direction, and it is a reason for a conversation with the doctor, not for stopping on your own. The final chapters cover movement, warmth and pressure on the legs, the other rheumatic conditions, and a plan for the medical appointment: the right question, the iron values, the medication list and a number to follow the course. WHAT IS IN THE BOOK- Why restless legs and fibromyalgia have to be considered together- How each of the two conditions is recognised- Six questions that separate the urge to move from constant pain- Why osteoarthritis stands at 4.4 per cent and fibromyalgia at 38.1- Central sensitisation as the shared ground- Sleep as the link, and what fatigue, concentration and mood have to do with it- Iron, inflammation and the other attempts at explanation- Pain in restless legs syndrome as a finding in its own right- Quality of life, and why sitting still matters more than walking distance- Lupus, spondyloarthritis and rheumatoid arthritis- The medicines that act on both, and those that help one and harm the other- Movement, warmth and your own plan for the medical conversation WHO THIS BOOK IS FORFor people with fibromyalgia whose legs will not stay still at night, for people with restless legs and widespread pain, and for health professionals who want to separate this common combination cleanly. ABOUT THE SERIESVolume 26 of 52 in the book series on restless legs syndrome, part 'RLS with Other Conditions'. Every volume can be read on its own. The statements in this volume rest on 161 professional sources, each one listed individually in the reference section.