Cannabis for Restless Legs Syndrome

Restless legs syndrome (RLS) is a condition that haunts the sleep of millions. Characterized by the intense feeling of needing to move one’s legs during periods of rest, this condition is more than just painful; it can disrupt everyday life in more ways than one. Disorders that disrupt sleep, like RLS, can cause a cascading host of other unwanted symptoms and conditions. Current treatments, such as movement or medications, help to treat the unwanted symptoms associated with the condition, but they do not get to the root cause of the problem. As Americans are waking up to the potential health benefits of cannabis, more and more patients are reporting that cannabis has provided significant relief from their worst symptoms. But what does the science say?

As it turns out, there’s a real possibility that cannabis could play a significant role in the management of this condition in the future and bring about real change for patients. Learn more about this condition and how cannabis may help bring relief to your patients today.

Restless Legs Syndrome
RLS, also known as Willis-Ekbom disease, is appropriately named for the experience it provides—a powerful and uncontrollable urge to move one’s legs. This need may be involuntary or in response to an uncomfortable sensation coming from within the body. These sensations have been described as feeling like aches and pains ranging from throbbing and pulling to the most uncomfortable—itching or crawling. The experience of these unpleasant sensations is most likely to happen during times of rest, whether it be sitting to relax or fully sleeping, making this condition even more frustrating for patients. As a result, many people report difficulties falling or staying asleep, which disrupts their ability to fully participate in their daily activities. Inability to concentrate, altered mood, decreased performance, and disrupted personal relationships have all been reported by patients suffering from this condition.

The National Institute of Neurological Disorders and Stroke believe that 7% to 10% of the population suffers from RLS.1 As noted by the Mayo Clinic, no one is safe from RLS, as it can affect anyone at any time. It’s noted, however, that restless legs tend to get worse with age and may affect women more than men.2 It’s believed that the condition may have a genetic component linked to its development, although more research is needed.

While the exact cause is still being researched, preliminary evidence suggests that RLS is related to neurological dysfunction in the section of the brain that controls movement. Dopamine and iron are two compounds potentially linked to its development. A deficiency in either of these chemical compounds may cause or worsen the disease.

Characteristically, symptoms of RLS are exacerbated by long periods of inactivity. Whether this is voluntary, for example, that which occurs when one sits in a car or airplane for a long ride or sits at work for long periods of time during the day, or involuntary, such as that experienced by someone with a mobile disability, this condition can severely negatively affect patients’ overall quality of life. Furthermore, the symptoms of RLS are sporadic and unpredictable. They may not occur every night, which is a welcome fact for those who suffer from this condition, but they can vary from night to night in presentation and severity. This makes it frustrating for the patient trying to achieve symptom management.

There is no cure for RLS, although lifestyle interventions and some medications may be prescribed to help control the symptoms. Iron supplements may also be recommended if indicated by blood testing. The most common and effective lifestyle intervention for managing RLS is simple movement. Most patients who suffer from RLS note that movement, whether it be walking, pacing, swinging the lower legs, or just turning over in bed, provides immediate relief from the uncomfortable symptoms. This, however, is difficult to manage at night, when the patient wants to be sleeping peacefully rather than pacing the house in search of relief. While the movement may temporarily relieve the sensation, returning to rest may mean the feelings will return. In the most serious cases, medications are used to help control the symptoms after lifestyle interventions have been implemented and found to be ineffective. The most prescribed medications include antiseizure drugs, dopaminergic agents, opioids, and benzodiazepines. While these medications may provide symptom relief, they do not address the root cause of the disease and may come with unwanted side effects.

Can Cannabis Help?
Ultimately, patients are looking for a more permanent solution that will help prevent them from experiencing RLS symptoms in the first place. They’re also looking for more natural solutions and alternatives to prescription medications, which is what leads so many to the ever-expanding world of medical cannabis. Anecdotally, patients report finding partial or complete relief from their symptoms with the use of cannabis, whether used medically or recreationally.3

While there’s no concrete data connecting the relief of RLS with cannabis yet, there is a promising theory that explains why patients are finding relief from their worst symptoms. As briefly mentioned previously, dopamine is one chemical that’s suspected to play a role in the development of this condition. As explained in Psychology Today, dopamine plays many different roles in the brain and body. The basal ganglia, a part of the brain that controls movement, uses dopamine to create smooth and controlled movements for the body.4 It’s understood that dopamine is critical for movement and that a disruption in dopamine production may cause a disruption in physical movement. As discussed in the journal Nature, it’s understood that THC consumption can have many effects on the dopamine system. Acute THC use can cause an increased release of dopamine, while long-term use can cause decreased release or depression of dopamine.5 This is why Psychology Today suggests that cannabis may be an effective solution for patients with RLS because the THC consumption may “prevent the excessive release of dopamine and restore normal neural activity in the basal ganglia.”4 More research is needed to explore this theory, but it remains promising.

Thankfully, some research is being done on the relationship between cannabis use and the relief of symptoms of RLS patients. A small study published by the Sleep Research Society examined the therapeutic effects of cannabis by collecting data from patients’ EHRs.6 Forty-one patients with a diagnosis of RLS who report using medical or recreational cannabis were studied, and they reported that cannabis helps relieve RLS symptoms, pain, and insomnia. Only one person reported cannabis did not help their symptoms. While this is a very small sample, the authors of the study strongly suggest that cannabis should be recognized as a potential solution and that more research is needed.

What Clinicians Need to Know
It’s clinicians’ responsibility to present the facts and help lead the patient in making an informed decision about the options that will best suit them and their unique needs. There’s not enough evidence to support recommending cannabis as a permanent solution to the pain and discomfort brought on by RLS, but that doesn’t mean your patients won’t be interested or asking about this option. Walking through what is known and unknown about cannabis and restless legs is a good place to start. Note that there’s no guarantee that cannabis will work for them, but if they are interested in experimenting, you can guide them to the best of your ability. As always, remember to treat the patients, not the condition, and work with them to find a cannabinoid, an application method, and a dose that’s appropriate for them and their unique needs.

— Emily Kyle, MS, RDN, CDN, CLT, HCP, is a certified holistic cannabis practitioner.

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