Long-Term treatment of a patient with severe restless legs syndrome using intrathecal morphine

Restless legs syndrome (RLS) is a common sensorimotor disorder.(1) The symptoms have a strong circadian rhythmicity and are most severe at night and at rest. In the most severe cases, symptoms are accompanied by serious sleep disturbances and unbearable paresthesias. First-line treatments of RLS are dopamine agonists, but GABAergic anticonvulsants and opioids are also effective.(2,3) Patients with the most severe RLS are often treated with oral opioids.(4) The use of these may, however, be limited due to side effects. The intrathecal administration of opioids results in better pain relief and fewer side effects in severe chronic pain. Case reports of 4 patients have documented excellent results with short-term use of intrathecal opioids also in RLS.