161: Crisugabalin for Refractory Painful Truncal Variant Restless Legs Syndrome: A Case Report

Topic: Clinical Science
Subtopic:

Background and Aims: Chronic back and abdominal pain are common presentations in pain clinics, but truncal variant restless legs syndrome (RLS) is frequently misdiagnosed as functional pain. Refractory cases unresponsive to both dopaminergic agents and first-generation α2δ ligands remain a major clinical challenge. Crisugabalin is a novel highly selective α2δ ligand with improved analgesic efficacy and safety profile.

Methods: A 69-year-old male presented with a 10-year intermittent nocturnal back pain and 6-year abdominal pain. Symptoms characteristically worsened at night and were partially relieved by movement or massage, causing sleep disruption. He had been misdiagnosed with chronic non-specific back pain and functional abdominal pain for years. Polysomnography showed a periodic limb movement index (PLMI) of 50/h. Serum ferritin was 69.3ng/ml, and all organic causes were excluded. Based on clinical features and polysomnography findings, he was definitively diagnosed with truncal variant RLS. He had received sequential standard treatments: pramipexole titrated to 0.5mg qn, then combined with pregabalin titrated to 150mg bid, but symptoms persisted despite maximum combination therapy.Pregabalin was discontinued and replaced with crisugabalin 40mg twice daily. Efficacy was tracked via the International Restless Legs Syndrome Rating Scale(IRLS), RLS-related Quality of Life scale (RLS-QoL) and the Clinical Global Impressions-Improvement scale (CGI-I) score at baseline, week 2, and 4.

Results: IRLS scores decreased from 21 (moderate) to 7 (mild), and RLS-QoL score improved from 56.25 to 60. CGI-I score was 1 (very much improved). These effects were sustained at week 4. The patient reported rapid onset of action, no adverse events, and has remained on crisugabalin 40mg bid with only rare symptom breakthrough.The patient remains stable on 40 mg BID.

Conclusions: This case demonstrates that crisugabalin is an effective and well-tolerated treatment option for refractory truncal variant RLS presenting with chronic back and abdominal pain, providing a new therapeutic choice for pain clinicians.

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Presenting Author: Wenlu Zhao
Submitting Author: Houzhen Tuo

Senior Author: Houzhen Tuo

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Wenlu Zhao - Beijing Friendship Hospital, Capital Medical University