目的:在阿片类药物戒断期间和之后,很少报道不宁腿综合征(RLS)的发展。我们旨在确定在有监督的阿片类药物逐渐减少期间和之后RLS症状的存在和严重程度。
方法:前瞻性招募了在Mayo疼痛康复诊所(PRC)中接受有监督的阿片类药物逐渐减少处方的97名成年人。入院时使用剑桥-霍普金斯问卷13和国际不安腿综合征研究组严重程度量表(IRLSS)评估RLS的存在和严重程度,中点,并从该计划中解雇以及2周,4周,完成后3个月。在入院和每个时间点之间比较RLS症状的频率和严重程度。
结果:队列的平均年龄为52.6±13.3岁,吗啡毫克当量(MME)剂量为45.6±48.3mg。RLS症状的频率从入院时的28%增加到PRC出院后两周的41%的峰值频率(p=0.01),阿片类药物停药3个月后恢复到接近基线的频率.IRLSS从基线增加,然后在入院后的每个时间点保持相对稳定。35(36.1%)的参与者在阿片类药物锥度期间出现了RLS的从头症状,暴露于较高MME剂量的患者发生RLS的风险更高。
结论:RLS的中度严重症状,根据调查评估,通常发生在经历阿片类药物逐渐减少的个体中,特别是当暴露于较高剂量时。在许多情况下,症状似乎是自我限制的,尽管少数人会出现持续的症状。我们的结果可能对成功的阿片类药物减量有影响,但考虑到慢性疼痛综合征患者可能出现RLS模拟症状,未来需要对结构化临床医师访谈进行验证性研究,以确定这些症状真正代表不宁腿综合征.
The development of restless legs syndrome (RLS) has been rarely reported during and following opioid withdrawal. We aimed to determine the presence and severity of RLS symptoms during and after supervised opioid tapering.
Ninety-seven adults enrolled in the Mayo Clinic Pain Rehabilitation Center who underwent supervised prescription opioid tapering were prospectively recruited. RLS presence and severity was assessed with the Cambridge-Hopkins Questionnaire 13 and International Restless Legs Syndrome Study Group Rating Severity Scale at admission, midpoint, and dismissal from the program as well as 2 weeks, 4 weeks, and 3 months after completion. Frequency and severity of RLS symptoms were compared between admission and each time point.
Average age of the cohort was 52.6 ± 13.3 years with a morphine milligram equivalent dose for the cohort of 45.6 ± 48.3 mg. Frequency of RLS symptoms increased from 28% at admission to peak frequency of 41% at 2 weeks following discharge from the Mayo Pain Rehabilitation Clinic (P = .01), returning to near baseline frequency 3 months after opioid discontinuation. International Restless Legs Syndrome Study Group Rating Severity Scale increased from baseline and then remained relatively stable at each time point following admission. Thirty-five (36.1%) participants developed de novo symptoms of RLS during their opioid
taper, with those being exposed to higher morphine milligram equivalent doses having higher risk of developing RLS.
Moderately severe symptoms of RLS, as assessed by survey, occur commonly in individuals undergoing opioid tapering, particularly if exposed to higher doses. In many cases, symptoms appear to be self-limited, although a minority develop persistent symptoms. Our results may have implications for successful opioid tapering, but future confirmatory studies with structured clinician interview are needed to establish that these symptoms truly represent restless legs syndrome given the potential for RLS-mimicking symptoms in individuals with chronic pain syndromes.
McCarter SJ, Labott JR, Mazumder MK, et al. Emergence of restless legs syndrome during opioid discontinuation. J Clin Sleep Med. 2023;19(4):741-748.