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The Link Between Restless Legs & Chronic Back Pain

February 9, 2018
Could dopaminergic medications ease “restless back” symptoms?

A PPM Brief

Success with low-dose levodopa in patients reporting chronic back pain has raised the question of whether certain back symptoms may be a variant of restless legs syndrome (RLS). A central nervous system agent used in the management of Parkinson’s disease, levodopa is indicated to treat shakiness, stiffness, spasms, tremors, and poor muscle control. Low-dose levodopa is also used as a first-line treatment for RLS. The report, published by Zeng et al, in the Journal of Pain Research, involved two middle-aged women presenting at a clinic in China.

In one case, the patient had hip and low back pain that, over a period of seven years, spread to her whole back and shoulders, presenting on occasion as “itchiness in the bones.” Symptoms worsened at night and when sitting or standing in a fixed position, resulting in an urge to move, twist, bend, stretch, and so forth. The patient fulfilled all four of the criteria for restless legs syndrome based on the International RLS Study Group consensus, but the symptoms were present in her back versus her legs, noted the researchers. Treatment with levodopa with bensarazide at a ratio of 4:1 provided significant relief.

The second case in the report involved a patient with lower back pain of 15 years, which kept her awake at night with the need to twist from side to side. She was diagnosed with RLS, and found her that her leg and back symptoms were both relieved upon being prescribed levodopa with benserazide.

Similarities in pathophysiologic mechanisms between RLS symptoms and the chronic back symptoms presented by the patients led the authors to link the two conditions. While they acknowledged that more research is needed to test whether these two cases can be repeated large scale, the authors went as far as naming the back condition “restless back,” and suggested that it may be able to be treated effectively with dopaminergic medications.

 

Last updated on: February 9, 2018
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