The main problem that RLS sufferers face when they visit their doctor for a diagnosis, is that the doctor is joined at the hip with the pharmaceutical industry, and all of its products. They're even given incentives by the Drug Companies to push their products. From ABC News ... Further investigation into the $6 billion spent by drug companies for what they say is a way to educate doctors showed that tactics like lavish gifts and trips are surprisingly common. "It's embarrassing, it's extravagant and it's unethical," said Dr. Arnold Relman, a Harvard Medical School professor and the former editor of the New England Journal of Medicine. "It makes the doctor feel beholden ... it suborns the judgment of the doctor." Few doctors were willing to talk publicly about their relationships with pharmaceutical companies, but one upstate New York doctor was willing to come forward. "It's very tempting and they just keep anteing it up. And it's getting harder to say no," said Dr. Rudy Mueller. "I feel in some ways it's kind of like bribery." Disgusted by how the free gifts and trips add to the high price of medicine, and moved by the plight of patients forced to skip needed medication, Mueller agreed to provide Primetime with a rare glimpse of the astounding number of drug company freebies he was offered by various drug companies in a four-month period. He was presented with an estimated $10,000 worth, including an all-expenses-paid trip to a resort in Florida, dinner cruises, hockey game tickets, a ski trip for the family, Omaha steaks, a day at a spa and free computer equipment." Brian Ross and David W. Scott, "Do Drug Company Perks Influence Doctors? How Pharmaceutical Companies Use Enticement to ?Educate' Physicians" ABC News abcnews.go.com/Primetime/story?id=132141&page=1 From the New York Times ... "In a scolding report, the nation's most influential medical advisory group said doctors should stop taking much of the money, gifts and free drug samples they routinely accept from drug and device companies. Drug companies spend billions of dollars wooing doctors - more than they spend on research or consumer advertising. Much of this money is spent on giving doctors free drug samples, free food, free medical refresher courses and payments for marketing lectures. The institute's report recommends that nearly all of these efforts end. The largest drug makers agreed last year to stop giving doctors pens, pads and other gifts of small value, but company executives have defended other marketing tactics as valuable to both doctors and patients. Medical device and biotechnology companies have yet to swear off free trips or even pens." Gardiner Harris, "Institute of Medicine Calls for Doctors to Stop Taking Gifts From Drug Makers" The New York Times (April 28, 2011) www.nytimes.com/2011/04/29/health/policy/29drug.html There are a few doctors moving toward a more natural practice, but they are few and far between. If a scientist happens to run a few tests one day on some poor mouse and discovers that inflammation is at the core of Restless Legs Syndrome, doctors are not going to start prescribing curcumin or ginger root to their RLS patients. Doctors prescribe drugs. That's what they're trained to do. If the issue is inflammation, what they will prescribe to you is a Nonsteroidal anti-inflammatory drug (NSAID). The problem is, NSAIDs usually feature powerful side effects that don't allow the patient to stay on them too long. Here's an excerpt from an article about Restless Legs Syndrome from the The NY Times website. "Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. In April 2005, the Food and Drug Administration asked drug manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for heart-related problems and digestive tract bleeding." The key words in the above summary are "NSAIDs worked well." So, that tells us something. It's a clue. It tells us the MAYBE inflammation is the problem. However, the profound side effects that NSAIDs create eliminate them an option as a long lasting remedy for RLS. This is where the herbs and supplements come in. They're just as effective and feature no dangerous side effects. Here is an exerpt from an article about the dangerous side effects of NSAIDs. "NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs. The most common side effects are nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. NSAIDs may also cause fluid retention, leading to edema. The most serious side effects are kidney failure, liver failure, ulcers and prolonged bleeding after an injury or surgery. Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is taken. People with asthma are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID. NSAIDs may increase the risk of potentially fatal, stomach and intestinal adverse reactions (for example, bleeding, ulcers, and perforation of the stomach or intestines). These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these adverse events. NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel disease." Omudhome Ogbru, Pharm.D., "Nonsteroidal Antiinflammatory Drugs (NSAIDs)" MedicineNet www.medicinenet.com/nonsteroidal_antiinflammatory_drugs/article.htm It's your choice on whether or not to avoid the unpleasantness. It's simply a case of changing one's attitude towards herbs and supplements. Again, scientific studies have proven that they're just as effective in the healing of inflammation. The rest of this page features an overview of NSAIDs and more about the potential side effects. Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, are drugs with analgesic, antipyretic (fever-reducing) and, in higher doses, with anti-inflammatory effects (reducing inflammation). The term "nonsteroidal" is used to distinguish these drugs from steroids, which (among a broad range of other effects) have a similar eicosanoid-depressing, anti-inflammatory action. As analgesics, NSAIDs are unusual in that they are non-narcotic. NSAIDs are sometimes also referred to as nonsteroidal anti-inflammatory agents/analgesics (NSAIAs) or nonsteroidal anti-inflammatory medicines (NSAIMs). The most prominent members of this group of drugs are aspirin, ibuprofen, and naproxen partly because they are available over-the-counter in many areas.110 NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs. The most common side effects are nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. NSAIDs may also cause fluid retention, leading to edema (observable swelling from fluid accumulation in body tissues). The most serious side effects are kidney failure, liver failure, ulcers and prolonged bleeding after an injury or surgery. NSAIDs also decrease the ability of the blood to clot and therefore increase bleeding. When used with other drugs that also increase bleeding [for example, warfarin (Coumadin)], there is an increased likelihood of serious bleeding or complications of bleeding. Therefore, individuals who are taking drugs that reduce the ability of blood to clot should avoid prolonged use of NSAIDs. Nonsteroidal antiinflammatory drugs also may increase blood pressure in patients with hypertension (high blood pressure) and therefore antagonize the action of drugs that are used to treat hypertension.108 Most NSAIDs penetrate poorly into the central nervous system (CNS). However, the COX enzymes are expressed constitutively in some areas of the CNS, meaning that even limited penetration may cause adverse effects such as somnolence and dizziness. In very rare cases, ibuprofen can cause aseptic meningitis. As with other drugs, allergies to NSAIDs might exist. While many allergies are specific to one NSAID, up to 1 in 5 people may have unpredictable cross-reactive allergic responses to other NSAIDs as well.110 The main ADRs (adverse drug reactions) associated with use of NSAIDs relate to direct and indirect irritation of the gastrointestinal tract (GIT). NSAIDs cause a dual insult on the GIT: the acidic molecules directly irritate the gastric mucosa, and inhibition of COX-1 reduces the levels of protective prostaglandins. Inhibition of prostaglandin synthesis in the GI tract causes increased gastric acid secretion, diminished bicarbonate secretion, diminished mucous secretion and diminished trophic effects on epithelial mucosa. Common gastrointestinal ADRs include: * Nausea/Vomiting * Dyspepsia * Gastric ulceration/bleeding * Diarrhea Risk of ulceration increases with duration of therapy, and with higher doses. In attempting to minimise GI ADRs, it is prudent to use the lowest effective dose for the shortest period of time, a practice which studies show is not often followed. Recent studies show that over 50% of patients taking NSAIDs have sustained damage to their small intestine.111 There are also some differences in the propensity of individual agents to cause gastrointestinal ADRs. Indomethacin, ketoprofen and piroxicam appear to have the highest prevalence of gastric ADRs, while ibuprofen (lower doses) and Diclofenac appear to have lower rates. Certain NSAIDs, such as aspirin, have been marketed in enteric-coated formulations which are claimed to reduce the incidence of gastrointestinal ADRs. Similarly, there is a belief that rectal formulations may reduce gastrointestinal ADRs. However, in consideration of the mechanism of such ADRs and indeed in clinical practice, these formulations have not been shown to have a reduced risk of GI ulceration.109 Commonly, gastrointestinal adverse effects can be reduced through suppressing acid production, by concomitant use of a proton pump inhibitor, e.g. omeprazole, esomeprazole; or the prostaglandin analogue misoprostol. Misoprostol is itself associated with a high incidence of gastrointestinal ADRs (diarrhea). While these techniques may be effective, they prove to be expensive for maintenance therapy.110 A recent meta-analysis of all trials comparing NSAIDs found an 80% increase in the risk of myocardial infarction with both newer COX-2 antagonists and high dose traditional anti-inflammatories compared with placebo.112 NSAIDs aside from (low-dose) aspirin are associated with a doubled risk of symptomatic heart failure in patients without a history of cardiac disease. In patients with such a history, however, use of NSAIDs (aside from low-dose aspirin) was associated with more than 10-fold increase in heart failure. If this link is found to be causal, NSAIDs are estimated to be responsible for up to 20 percent of hospital admissions for congestive heart failure.113 NSAIDs are also associated with a relatively high incidence of renal adverse drug reactions (ADRs). The mechanism of these renal ADRs is due to changes in renal haemodynamics (blood flow), ordinarily mediated by prostaglandins, which are affected by NSAIDs. Prostaglandins normally cause vasodilation of the afferent arterioles of the glomeruli. This helps maintain normal glomerular perfusion and glomerular filtration rate (GFR), an indicator of renal function. This is particularly important in renal failure where the kidney is trying to maintain renal perfusion pressure by elevated angiotensin II levels. At these elevated levels, angiotensin II also constricts the afferent ateriole into the glomerulus in addition to the efferent arteriole one it normally constricts. Prostaglandins serve to dilate the afferent arteriole; by blocking this prostaglandin-mediated effect, particularly in renal failure, NSAIDs cause unopposed constriction of the afferent arteriole and decreased renal perfusion pressure. Horses are particularly prone to these adverse affects compared to other domestic animal species. Common ADRs associated with altered renal function include: 109 * Salt and fluid retention * Hypertension (high blood pressure) These agents may also cause renal impairment, especially in combination with other nephrotoxic agents. Renal failure is especially a risk if the patient is also concomitantly taking an ACE inhibitor and a diuretic - the so-called "triple whammy" effect.114 In rarer instances NSAIDs may also cause more severe renal conditions:109 * Interstitial nephritis * Nephrotic syndrome * Acute renal failure * Acute tubular necrosis NSAIDs in combination with excessive use of phenacetin and/or paracetamol may lead to analgesic nephropathy.115 Photosensitivity is a commonly overlooked adverse effect of many of the NSAIDs.116 It is somewhat ironic that these anti-inflammatory agents may themselves produce inflammation in combination with exposure to sunlight. The 2-arylpropionic acids have proven to be the most likely to produce photosensitivity reactions, but other NSAIDs have also been implicated including piroxicam, diclofenac and benzydamine. Benoxaprofen, since withdrawn due to its hepatotoxicity, was the most photoactive NSAID observed. The mechanism of photosensitivity, responsible for the high photoactivity of the 2-arylpropionic acids, is the ready decarboxylation of the carboxylic acid moiety. The specific absorbance characteristics of the different chromophoric 2-aryl substituents, affects the decarboxylation mechanism. While ibuprofen is somewhat of an exception, having weak absorption, it has been reported to be a weak ph.110

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