Ask Dr Gary: Relief at hand for achy legs

For many years my wife has suffered with aching legs at night when trying to sleep. She works part time as a caregiver in a rest home and is on the go for the full shift. Is there anything you can suggest which may help her?

- Bill

Restless legs syndrome (RLS) describes the almost insatiable urge to move the legs or walk to stop extremely uncomfortable "pins-and-needles" leg pains. It is thought to affect about 5 per cent of the population, and is more common in women than men. It typically worsens with age.

Symptoms are at their worst at bedtime, and best upon awakening in the morning. Walking brings immediate, if short-lived, relief. RLS occurs while people are awake and asleep, and interferes with the restful stage of deep sleep known as REM sleep.

It has been been the subject of a great deal of inappropriate pharmaceutical marketing - leading some to think it's a made-up disease - but it's not.

Suffice to say that some people really do suffer from it, including up to 1 in 5 women in later pregnancy.

About 20 per cent of RLS sufferers are iron deficient, and correcting the deficiency with iron supplementation cures the problem in most of these people. Varicose veins and thyroid disease are also associated with RLS. Getting screened for these is a good starting point.

RLS is also strongly associated with low dopamine levels, a feature it shares with the neurological disorder Parkinson's disease.

Many Parkinson's medications are successfully used to treat RLS. Conversely, medications that lower dopamine such as anti-psychotic medications, anti-depressants, and some anti-nausea medications can actually cause or worsen RLS symptoms.

The mainstay of treatment has focused on increasing dopamine levels in the brain. One drug that does this is pramipexole, which became funded through Pharmac last year.

Drugs with other mechanisms of action like gabapentin and methadone have also been used to treat RLS.

Have your wife chat with her doctor to first get an accurate diagnosis, and then plan a strategy that at least manages, if not cures, her symptoms.