Cannabis Use for Restless Legs Syndrome and Uremic Pruritus in in patients treated with maintenance dialysis: A Survey

Abstract

Background: Restless legs syndrome (RLS) and uremic pruritus reduce the quality of life in patients with end-stage kidney disease (ESKD) and current treatments are often insufficient. There is an increasing interest in using cannabinoids for symptom management, and preliminary evidence suggests cannabinoids may help alleviate RLS and pruritus. Objectives: (1) To assess the frequency and severity of RLS and pruritus in our ESKD population with the current treatment options, (2) to estimate patient use of cannabinoids for these symptoms, and (3) to determine interest in participating in future trials to treat RLS and/or pruritus. Design: Survey. Patients: Adult prevalent patients with ESKD treated with dialysis at the Ottawa Hospital. Measurements: International RLS Study Group Rating Scale and visual analogue scale for symptom severity of RLS and pruritus, respectively. Methods: Eligible patients with ESKD treated at the Ottawa Hospital were invited to complete a survey to identify symptoms and severity of RLS and pruritus using validated scales, cannabis use for management, and interest in future trials. Basic demographic statistics to describe the study population and results were used. Results: Sixty-nine percent (192 of 277) of eligible patients completed the surveys, 35 declined participation, and 50 surveys were not returned. Eighty-six (45%) and 129 patients (67%) reported symptoms of RLS and pruritus, respectively. Only 18 previously symptomatic patients were relieved with current treatment. Fifteen patients reported cannabis use for symptoms; 9 noted improvement. Most (>2 of 3) symptomatic patients were interested in participating in a future trial. Limitations: Single-center study in a tertiary-care hospital in Canada limiting generalizability. Quoted prevalence of symptoms is dependent on survey return. Conclusions: A large proportion of ESKD patients suffer from RLS and/or pruritus, most of which are not relieved by existing treatments. Few patients reported trying cannabis to decrease their symptoms despite legalization. This study confirms strong patient interest for future trials regarding cannabis for symptom relief. Trial Registration: Not applicable.

The Effects of Cannabinoids on Sleep

“…There are some case series reporting improvement in RLS symptoms with the use of cannabis products. 63 , 64 Cannabis products have potential analgesic properties for those with a chronic pain manifestation of their RLS symptoms; additional mechanisms may relate to the anxiolytic and/or sedative hypnotic effects of these products but are generally unknown at this time. 65 , 66 There is a lack of objective efficacy measures with the use of cannabis for RLS in the literature.…”

A Narrative Review of the Lesser Known Medications for Treatment of Restless Legs Syndrome and Pathogenetic Implications for Their Use

“…The positive response to cannabinoids in the following two case reports [67,68] suggests that the cannabinoid receptor may be downregulated in RLS, although we know of no basic science inquiries into this possibility at present. In the first of the case reports, 6 patients from France with long duration (5-23 years) and very severe RLS (IRLS scale score range from 32 to 37 on a 40-point scale) reported that they on their own had taken cannabis for their RLS with complete resolution of symptoms (no p-value provided) despite having previously failed multiple standard RLS medications such as dopamine agonists, gabapentin, pregabalin, and opioids [67].…”

CBD and THC - influence on insomnia, sleep apnea and restless leg syndrome - review based on recent advances

“…Mimo ograniczonej ilości badań, wstępne wyniki są dość obiecujące [3,16]. W badaniach na zwierzętach dowiedziono, że kannabinoidy zmniejszają bezdech podczas snu, ale też mogą ubocznie powodować zmniejszenie fazy REM i spadek wydajności snu [2,3,18,19]. Zastrzyki z syntetycznej postaci THC (dronabinol) podawane do zwojów guzowatych gryzoni, powodowały stłumienie odruchowych bezdechów wywoływanych przez serotininę i oddziaływały na mięśnie rozszerzające górne drogi oddechowe, zwiększając ich aktywność [20].…”

“…Dzięki badaniom na ludziach potwierdzono, że dronabinol (delta-9-tetra-hydrocannabinol) zmniejsza wskaźnik bezdechu i spłycenia przepony oraz subiektywną senność. Wyniki badań wpływu kannabinoidów na OBS są obiecujące, lecz potrzebne są badania oceniające długoterminową skuteczność i potencjalne skutki uboczne [2,3,19].…”

“…Chorobę można także powiązać z neuroprzekaźnikami takimi jak glutaminian, kwas gamma aminomasłowy i endogenne opioidy [2,3]. Obecne leczenie polega na stosowaniu leków zastępujących dopaminę, agonistów dopaminy i ligandy kanałów wapniowych alfa-2-delta [19]. Leczenie obejmujące środki dopaminergiczne , które jest standardem, wiąże się z poważnymi skutkami ubocznymi mogącymi wystąpić w trakcie terapii m.in.…”