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Restless Leg Syndrome Or Neuropathy

Today's post from clinicaladvisor.com (see link below) looks at a question that confuses both patients and doctors alike and that is whether you have restless leg syndrome, or neuropathy, or both! Because the symptoms seem to be similar, it's sometimes difficult to distinguish between the two, although people with restless leg syndrom may argue that their symptoms are even more unique than those of neuropathy patients. Also, it may be technically true that RLS is a form of neuropathy in itself. Either way, it's a very annoying complaint and may be treated somewhat differently than 'normal' neuropathy. Your doctor should be able to help and refer you to a specialist if necessary. Useful article.

Is it restless leg syndrome or neuropathy?
Sharon M. O'Brien, MPAS, PA-C March 11, 2015 

Take the time to make the distinction between restless leg syndrome and neuropathy.

This week, a third patient came with a diagnosis of restless leg syndrome (RLS) when a more accurate diagnosis should have been neuropathy. Consequently, I thought I should try to clarify the difference between the two.

RLS is loosely defined as having pain in the extremities, especially during relaxation, that is eased by movement or walking. The symptoms are often characterized as "creepy crawling" or "jumpy legs" but are described as painful at times. However, there are more specific criteria that need to be met in order to make a diagnosis. (See below.)

Restless leg syndrome occurs in about 10% of the population and tends to run in families, so ask patients if anyone else in the family has similar symptoms or has been previously diagnosed with RLS.

The diagnostic criteria for RLS is defined in the International Classification of Sleep Disorders as follows: 
 
"The patient reports an urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.
The urge to move or the unpleasant sensations begin or worsen during periods of rest or worsen during periods of rest or inactivity such as lying or sitting.
The urge to move or the unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity
The urge to move or the unpleasant sensations are worse, or only occur, in the evening or night.
The disorder is not better explained by another current sleep disorder, medical or neurological disorder, medication use, or substance use disorder."1

Neuropathy is described as burning, shooting, electrical, pins-and-needles type of pain in the extremities. This pain is usually not eased by walking, and many patients complain that movement makes the pain worse. This pain is generally present most of the time and does not change during particular times of the day.

What can make a diagnosis difficult is when a patient has neuropathy and RLS, as the two can occur together. RLS can also be seen in patients with kidney disease, Parkinson's disease, and iron deficiency. It is often seen in pregnancy and can be seen in patients taking antidepressants or antipsychotic drugs.

Besides the patient complaints, check a ferritin level in patients suspected of having RLS. Iron levels should be kept above 50 ng/mL in patients who have symptoms. Add iron if levels fall below. If this does not control symptoms, medications that can be helpful include ropinirole and pramipexole. I often try gabapentin for RLS, especially if there is a neuropathic component as this can help both.

The most important questions to ask your patients are:
When does the pain occur?
Does movement make the pain go away or feel better?

These questions will most likely help you with the diagnosis. In most cases, if the pain is occurring with inactivity, in the evening, and walking makes the pain feel better, then you are safe to assume it is RLS. If not, look for something else.

Have you had a difficult time distinguishing between RLS and neuropathy?

Sharon M. O'Brien, MPAS, PA-C, is a practicing clinician with an interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.

Reference
American Academy of Sleep Medicine. International Classification of Sleep Disorders, 2nd edition, pocket version: Diagnostic and Coding Manual. Westchester, Illinois: American Academy of Sleep Medicine, 2006.
 
http://www.clinicaladvisor.com/restless-leg-syndrome-neuropathy-differences/article/402886/

Organizer Treatment for sciatic nerve leg pain

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Why Are You Feeling So Much Leg And Foot Pain

Today's post from huffingtonpost.com (see link below) looks at the various possible reasons for having leg pain. As neuropathy cases increase and more and more people become aware of what it is, it's important to realise that not all leg and foot pains may be the result of nerve damage. There are other better-known causes of leg and foot pain and it's important to exclude those before coming to any conclusions regarding neuropathy. This article is a useful one and provides lots of information to help you decide what may be causing your discomfort. Your doctor may tell you otherwise in the end but at least you'll have some understanding of the possible diagnoses and a basis for discussion with your doctor.

This May Be Causing Your Leg Pain And Numbness
Leg discomfort can knock you off your feet and it should never be ignored.
Winnie Yu Next Avenue 2017

Aching calves, burning legs, numbness in the feet — pain and discomfort in the lower extremities is a common complaint that sends many of us to our doctors seeking relief.

But unless the cause is something obvious, like a fall, pinpointing the source may require some medical detective work. Trying to tough it out, though, will not get you any closer to the answers.

“Leg pain that comes on acutely with a bang, is severe and doesn’t resolve within minutes probably needs to be seen right away,” as it could be a sign of a more serious condition, says Dr. Benjamin Wedro, a clinical professor of medicine at the University of Wisconsin and an emergency physician at Gundersen Medical Center in Lacrosse, Wis. “There’s no trophy for suffering.”

Here are some of the potential causes of leg and foot pain:

Blood Vessel Distress

Pain that occurs when walking or exercising may be the result of claudication or decreased blood supply to the legs. This condition is most often a symptom of peripheral arterial disease, or PAD, a narrowing of the arteries that deliver blood to your limbs, typically caused by the buildup of plaque or fatty deposits. Smoking, high cholesterol, high blood pressure and obesity are major risk factors for PAD.

“The leg pain from PAD tends to occur when you’re active,” says John Fesperman, a family nurse practitioner at Duke Primary Care in North Carolina. “When you’re active, muscles need more blood. The lack of adequate blood triggers pain, which is known as intermittent claudication. Once you stop moving, the pain usually disappears.”

Deep vein thrombosis, or DVT, a blood clot in a deep vein that develops after extended periods of inactivity, can also cause major leg pain. Long flights or car rides make it difficult for the leg to return blood back to the heart. If that blood return slows or stops, it can create a clot within the vein. And if part of a clot breaks off and travels to the lungs, it can cause a pulmonary embolism, a serious and potentially fatal blockage of blood flow to the lungs.

DVT usually occurs in only one leg, Wedro says, causing it to swell and turn a bluish hue. “The onset of pain is gradual and tends to occur over a course of hours,” he says.

Peripheral Neuropathy

In some people, leg and foot (and sometimes arm and hand) pain can be the result of neuropathy, a disorder of the peripheral motor, sensory and autonomic nerves that connect the spinal cord to our muscles, skin and internal organs. Neuropathy can cause numbness, tingling and a heavy sensation. “It usually starts in the feet and may cause a burning sensation in the legs,” Fesperman says. In some cases, people may lose their ability to feel sensation in their legs, which can put them at risk for injury and infection.

Neuropathy can be brought on by many factors, including infection, toxins and the effects of alcoholism, but diabetes is the most common cause. According to the Neuropathy Association, approximately 60 to 70 percent of people with diabetes will at some point develop peripheral neuropathy. It can also affect people who have pre-diabetes and may not be experiencing any other diabetic symptoms.

Electrolyte Imbalance

Healthy muscle function depends on nerves being supported by a well-balanced mix of electrolytes — minerals like sodium, potassium, calcium and magnesium that have an electric charge. Electrolytes transmit signals that support nerve, heart and muscle function, and affect the amount of water in your body as well.

But certain medications; dehydration; and conditions like diarrhea and kidney disease can alter your electrolyte balance. When electrolyte levels become too low, it can cause leg pain. For example, when sodium, which attracts water to cells, is depleted, cells straining to compensate for the lack of fluid can bring on painful cramps.

Diuretics prescribed to control blood pressure are the most common culprits, Fesperman says, because they can deplete electrolytes in the blood. “Potassium and calcium mediate muscle contraction,” he says. “An imbalance in either or both can cause muscle cramping.”

By reducing blood flow, dehydration can cause electrolyte imbalance, and cramps, as well. Likewise, if you drink too much water, you can flush out too many electrolytes.

Back Problems

Conditions that affect your back often lead to pain in the legs as well. Spinal stenosis, in which the spinal canal gradually narrows, pressuring the nerves, usually affects people over 50 and can be caused by arthritis, scoliosis or spinal injury. The pressure can impinge on nerve roots as they leave the spinal cord to form the sciatic nerve, the body’s largest. The irritated nerves can cause significant pain.

Sciatica, a painful inflammation of the sciatic nerve, is typically experienced on one side of the body, and can travel from your lower back down your leg to your feet or even toes. Sciatica is difficult to diagnose and sometimes goes away on its own. It can be brought on by spinal stenosis.

“Sciatic and spinal conditions may come on gradually over time but may also have an acute onset,” Wedro says. “Over time, what had been tolerable becomes an acute issue. Sciatic nerve inflammation caused by changes in the back, such as arthritis, muscle spasm or injury, may radiate into the buttocks and down the leg.”

If the leg pain is accompanied by the loss of bladder or bowel control or numbness near the anus or vagina, seek emergency care immediately. You may have cauda equina syndrome, a rare disorder affecting the nerve roots at the lower end of the spine. Without immediate treatment, the spinal cord can shut down and you may develop permanent paralysis.

Arthritis

There are many types of arthritis. Osteoarthritis, the most common form, breaks down the cartilage in your joints, causing a buildup of painful bone spurs, cartilage loss, inflammation or soreness. Rheumatoid arthritis, an autoimmune disease, attacks the lining of the joints, also causing inflammation and pain.


Although arthritis is a joint disease, the pain it causes can be felt in the surrounding leg and foot muscles. “Any joint under stress can cause pain,” Wedro says. “The pain is within the joints. But the muscles around it try to protect it and you can go into spasms and get secondary muscle pain.”

Getting Treatment for Leg Pain

The appropriate treatment for leg pain depends on the underlying cause. Diabetics may need to improve their blood glucose control to prevent diabetic neuropathy, while arthritis sufferers may need medication or surgery.

“All treatments aim for long-term control of symptoms,” Wedro says. “There may not be one cocktail that works for everybody. It all depends on what has caused the leg pain. It will be trial and error for you and your doctor to find the treatment that works.”

The bottom line? Take all leg and foot discomfort seriously. “Pain means part of the body isn’t working right,” Wedro says. “The problem might be a disaster that is life- or limb-threatening, or it may be an inconvenience that might resolve with a little time and care. But if you have pain, see your doctor. Never dismiss it.”

http://www.huffingtonpost.com/entry/this-is-what-may-be-causing-your-leg-pain-and-numbness_us_57fd2a14e4b0b6a43035e269

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