{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:12:24Z","timestamp":1747185144960,"version":"3.40.5"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T00:00:00Z","timestamp":1629072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\u201cChronic pain\u201d is a commonly reported symptom among hemodialysis patients. Despite its high prevalence and the poor health\u2010related quality of life associated with it, chronic pain remains an ineffectively assessed and managed entity in dialysis patients. We report a case of a 55\u2010year\u2010old gentleman on maintenance hemodialysis who presented with 3\u2009months history of \u201cexcruciating flitting and fleeting type\u201d of pain largely involving both lower limbs and occasionally neck, shoulder, chest, and upper limbs. The pain was so intolerable that it even triggered suicidal intentions in the patient. Common causes of chronic pain in dialysis patients were considered, but the initial history and clinical examination remained elusive. The patient was empirically started on oral analgesics, benzodiazepines, calcitriol, and levocarnitine supplementation but had no significant effect on his symptoms. A comprehensive repeat clinical history revealed the nocturnal periodicity of symptoms, specific aggravation of pain with inactivity, and its temporary relief with movement. This helped us narrow down the diagnosis to restless leg syndrome (RLS) amidst the myriad causes of chronic pain in dialysis patients. The \u201cconstant urge to move the legs\u201d which is the defining characteristic of RLS was inconspicuous in our patient and excruciating pain was the predominant manifestation. This atypical presentation of RLS with agonizing pain involving multiple sites of the body led to a delay in the diagnosis and initiation of appropriate therapeutic measures. The patient had a dramatic response to therapy with dopamine agonists and withdrawal of the drug led to reappearance of his symptoms which further confirmed the diagnosis of RLS. RLS should be considered in the evaluation of chronic pain in dialysis patients and renal health care providers should familiarize themselves with the varied atypical, forme fruste manifestations of RLS to avoid diagnostic delay of this disabling but treatable condition.<\/jats:p>","DOI":"10.1111\/hdi.12978","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T07:30:23Z","timestamp":1629099023000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Restless leg syndrome presenting as chronic severe limb pain in a dialysis patient"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3956-165X","authenticated-orcid":false,"given":"Subrahmanian","family":"Sathiavageesan","sequence":"first","affiliation":[{"name":"Department of Nephrology Trichy SRM Medical College Hospital and Research Centre  Trichy Tamil Nadu India"},{"name":"Department of Nephrology Sundaram Hospital  Trichy Tamil Nadu India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0258-3804","authenticated-orcid":false,"given":"Ishwarya","family":"Annamalai","sequence":"additional","affiliation":[{"name":"Department of Nephrology Trichy SRM Medical College Hospital and Research Centre  Trichy Tamil Nadu India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arunkarki","family":"Malayappan","sequence":"additional","affiliation":[{"name":"Department of Medicine Trichy SRM Medical College Hospital and Research Centre  Trichy Tamil Nadu India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamalanathan","family":"Melchizedek","sequence":"additional","affiliation":[{"name":"Department of Nephrology Trichy SRM Medical College Hospital and Research Centre  Trichy Tamil Nadu India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjitha","family":"Ramajayam","sequence":"additional","affiliation":[{"name":"Department of Nephrology Trichy SRM Medical College Hospital and Research Centre  Trichy Tamil Nadu India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anjali","family":"Annadurai","sequence":"additional","affiliation":[{"name":"Department of Nephrology Trichy SRM Medical College Hospital and Research Centre  Trichy Tamil Nadu 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