Restless legs syndrome (RLS) can start or worsen when you begin to wean off opioid medications. In fact, research shows that up to 50 percent of people enrolled in an inpatient detoxification program for opioid use disorder experience RLS symptoms.

While there’s no known cure for the disorder, treatment options are available to ease the discomfort. In this article, we’ll explain what RLS is, how it’s related to opioid tapering, and which treatment options can provide relief.

What Is Restless Legs Syndrome?

RLS is a movement disorder that causes an intense urge to move your legs. Symptoms may include uncomfortable sensations such as:

• Aching
• Throbbing
• Crawling
• Itching
• Burning

🗳️ Have you experienced restless legs syndrome (RLS) while tapering off opioids?

Yes, and my symptoms improved over time

Yes, and I’m still experiencing symptoms

No, I haven’t experienced RLS

I’m not sure if my symptoms are RLS or general restlessness

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These sensations typically get worse at night or when you’re resting, and they usually improve at least temporarily when you move and walk around.

Generalized Restlessness vs. Restless Legs Syndrome

Opioid withdrawal can sometimes cause generalized restlessness. This type of restlessness may cause anxiety and a need to move your whole body. Although some symptoms overlap, generalized restlessness and RLS are not the same.

RLS mainly affects the legs and often gets worse at night, while generalized restlessness can happen at any time of day and affects the whole body or mind. RLS is also temporarily relieved with movement, whereas generalized restlessness can be continuous.

How Long Does Restless Legs Syndrome Last After Opioid Tapering?

RLS symptoms can last weeks to months after you wean off opioids and may peak around two weeks after completing a supervised opioid taper.

Studies show that symptoms may be most intense about two weeks after discharge from an opioid treatment program but tend to improve by three months. However, some people may experience persistent symptoms.

Living with RLS for weeks to months can be uncomfortable, and the resulting sleep disruptions may affect your recovery. Research has found that some people return to opioid use to relieve RLS symptoms.

RLS has also been associated with an increased risk of self-harm and suicidal ideation. For these reasons, stay in close contact with your treatment team as you manage RLS.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or using the online chat.

What May Help With Restless Legs Syndrome During Opioid Withdrawal?

RLS treatment depends on the underlying cause. Tell your healthcare provider right away if you develop any RLS symptoms, as they may recommend adjusting your opioid tapering schedule or exploring other treatment options.

Addressing Underlying Causes

Because low iron levels are associated with an increased risk of RLS, your healthcare provider may recommend blood tests to check your iron levels. If your iron level is too low, taking an iron supplement may help.

Your healthcare provider may also evaluate other conditions or medications that could be contributing to your symptoms.

Medications and Other Treatments

There are prescription medications available to treat RLS symptoms during and after your opioid taper.

First-line medications for RLS include gabapentin (Neurontin) and pregabalin (Lyrica). These medications help calm the nervous system and may relieve symptoms that affect your sleep. However, they can cause serious side effects when combined with opioids, including slowed breathing.

Buprenorphine is another prescription medication that can help manage opioid withdrawal symptoms and may also relieve RLS symptoms. However, starting buprenorphine requires close monitoring from a healthcare provider. Your provider may recommend inpatient treatment if you have difficulty starting buprenorphine as an outpatient.

Other treatment options include:

• Cognitive behavioral therapy (CBT), which can help improve sleep through relaxation and mindfulness strategies
• Peroneal nerve stimulation, which uses a device that delivers an electrical signal to your leg muscles

Finally, some people have reported that taking a magnesium supplement has relieved their RLS symptoms. However, there isn’t enough evidence to know whether magnesium supplements are safe and effective for treating RLS.

At-Home Strategies and Supplements

In addition to medication adjustments, there are steps you can take at home to improve your symptoms, such as:

• Walking, jogging, or doing other gentle exercise every day
• Soaking your legs in warm water before bedtime
• Stretching your legs before getting into bed
• Massaging your leg muscles each day
• Avoiding alcohol and nicotine, which can worsen symptoms

Because RLS disrupts sleep, it’s important to use strategies that support quality sleep. Try any of the following tips if you’re experiencing disrupted sleep:

• Try not to have caffeine too close to bed, as caffeine may trigger RLS symptoms.
• Aim to go to bed and wake up at the same time each day.
• Keep your bedroom cool, dark, and quiet.

Talk with your healthcare team if you’re experiencing RLS symptoms. Effective treatment options are available to help manage your symptoms during recovery.