Kratom for pain

Using Kratom for Chronic Pain

and Restless Legs Syndrome (RLS)

A Booklet By Mary Leonhardt

Introduction: 

Disclosure

This is a book about my personal experiences with kratom.  I write about it as a sufferer of chronic pain, and severe restless legs syndrome (RLS). I am not a doctor.  I am not a medical researcher.  I did do some research about kratom, before I started using it, but I used only sources that are available to everyone. I am not advising anyone else to use kratom, as I don’t think I have any right to do that.  I am just telling you my experiences.   I know that both chronic pain, and RLS, are complicated conditions, and may respond to different treatments in different people.  Kratom may not work for you. But it has been a wonderful, life-saving herb for me.  And so I wanted to pass along my story.

For more information about Kratom go to www.americankratom.org

Chapter Two: What to Do? | Chapter Three: What's Kratom? | Chapter Four: Making a Decision | Chapter Five: Trying Kratom | Chapter Six: The Nuts and Bolts | How to Take It | How Much to Take | How Often to Take It | Withdrawal

Chapter One:  Background

I’m seventy years old, and can barely remember a time when I wasn’t bothered by restless legs syndrome, and by chronic back pain.  The back pain I could manage pretty well with daily exercises.  For most of my life, the RLS--those unpleasant, crawly sensations in my legs that made it imperative for me to move around—were intermittent and fairly mild. 

I could manage them with a short walk, a hot bath, or a variety of over-the counter remedies.  Then, about three years ago, the RLS became much more severe, and my back pain was starting to need more than daily exercise. I went to a chiropractor for my back pain. 

I had an MRI and was diagnosed with mild degenerative disc disease and moderate to severe facet joint osteoarthritis, as well as moderate narrowing of the spinal canal, secondary to some disc bulging. 

The exercises and the chiropractor helped, and if that had been my only problem, IKratom would have been okay.  Yes, the pain was often troubling, but I had no desire to go on heavy pain medications.  When I got very uncomfortable, Advil usually helped, although I worried sometimes that I was taking too much of it. In addition to the back pain, a few years ago I developed shoulder pain, with inflamed rotator cuffs.

I also do exercises for my shoulders, which help quite a bit and, again, Advil helped. But, meanwhile, the RLS was getting much worse, and nothing I was taking seemed to help it.  Gradually, it wasn’t just one or two nights a month that I was awakened by the absolute need to get out of bed and start walking; it was every night. 

And not just once or twice a night—sometimes, it seemed, the entire night.  From being a good sleeper, I started averaging only two or three hours of sleep a night.  Some nights I barely slept at all, in spite of all of the over-the counter remedies that used to work, as well as two or three hot baths.

In addition, being able to sit and read or watch a video on the couch in the evening became impossible.  After only a few minutes, the feeling in my legs made me get up and move around.  I stopped even trying to go to movies or a show in the evening.

One of my children lives across the country from me, and one lives in Hawaii.  I found I was also now dreading airline flights.  Even though the RLS was most disabling at night, it seemed that no matter what time I scheduled an airline flight, my legs acted like it was the middle of the night.  Having to sit through a long flight had gone from being bothersome to being almost unbearable.

So I started doing research.  The back pain was no mystery: exercise, Advil, and some visits to the chiropractor could keep it somewhat in check.  But I had no idea what to do for the RLS. I searched “restless legs syndrome” and read everything I could find on it. 

Here’s the short version: Restless legs syndrome has been renamed Willis-Ekbom Disease (WED), principally, I gathered, because the medical profession was now understanding the seriousness of the condition—and “restless legs” doesn’t sound that serious.  But since RLS is the more common name, I’ll use that term in this book.

It turns out that, although there are many theories of its cause--usually centering around a lack of dopamine, or a lack of iron, or too much glutamate--no one knows why someone develops it, or how to cure it.  That last part was very clear:  no one had a cure for RLS.  The most to hope for was that some way would be found to “manage” it. The only glimmer of hope I found in my research was the theory that some cases of RLS were secondary to some other, treatable condition—such as low iron, or low vitamin D.  Pregnancy seemed to cause a flare-up of it, and it seemed to accompany some other diseases, such as Multiple Sclerosis and Diabetes. 

KratomThe hope was that managing these other diseases--or waiting for the pregnancy to end--would also cause a remission of the RS. It’s hard to get accurate statistics on how common the condition is, since many sufferers don’t realize that it’s a definite disorder, and so don’t seek medical help.  However, the National Institute of Neurological Disorders and Stroke (NIH) estimates the percent of people affected may be as high as ten percent, with two to three percent of the population having moderate to severe RLS.  NIH also estimates that as many as a million children may be affected.  I find this especially heartbreaking, as kids being diagnosed as hyperactive, or behavior-disordered, may be suffering from RLS.  They won’t sit still when told to because they can’t.

The best medical description of the condition I found was in a book titled Clinical Management of Restless Legs Syndrome by Hochang B. Lee, Mark J. Buchfuhrer, Richard Allen, and Wayne A. Hening.  It’s available on Amazon, and I highly recommend it.  Get the second edition.  It lists five diagnostic criteria for RLS which are, essentially, that sufferers feel a compulsion to move their legs, the compulsion is strongest after a period of rest, movement relieves the compulsive feeling, the urge happens mostly in the evenings and at night, and this compulsion to move is not caused by anything else.

This book, Clinical Management, also outlines treatment options.  Essentially, it recommends first to do the kinds of things I was already doing:  exercise, watching my diet, hot baths, etc.  When these mild interventions stop working, it recommends a class of drugs called dopamine agonists (DA’s).  In searching the Internet, I found that, indeed, most sufferers of this disease report that these are the drugs most prescribed.  

The most helpful site I found on the Internet was that of the Willis Ekbom Disease postings from this discussion board, and a couple of things jumped out at me.   One was that most people who bother to post are those suffering the severe form of RLS.  So this was definitely my group.  And many had been struggling with severe RLS for years, and had undergone all of the available treatments. It was their experiences that I was most interested in, as I was trying to decide what to do myself. 

I knew I had to do something, as the RLS was now having a major, negative impact on my life.  Combined with my chronic back pain, it was making my life very difficult.  It seemed like I was exhausted and in pain much of the time.

Almost uniformly, the posters reported being put on a DA by their doctors (usually neurologists or primary care doctors) after their RLS became severe.  The good news was that the DA’s seem to control RLS symptoms pretty well.   But, for me, the bad news almost overwhelmed the good news.

First of all, there are significant side effects to the DA’s.  Common ones are headaches, nausea, and either sleepiness, or trouble sleeping.  More severe ones included compulsive behavior, such as gambling, or compulsive eating.

That was troubling enough, but for me the showstopper was that in some cases—and I’ve seen statistics all over the place as to how many cases—people on DA’s eventually augment.  This means their RLS gets worse.  While before starting the DA’s the symptoms were confined primarily to their legs, and happened primarily in the evenings and at night, after being on a DA it sometimes started happening all over their bodies, and was active twenty-four hours a day.  

Some sufferers on the discussion boards reported that they had a pretty long run on the DA’s—some as long as ten years—before running into augmentation.  Others seemed to experience it fairly quickly.  But once it happens, the general consensus seemed to be that you would eventually—and probably quickly—augment on all of the other DA’s as well.

There well may be many, many people who never augment on these drugs, who take them for years, for their lifetime, without running into problems.  These people most likely don’t bother to go online and read the forums, since they’re doing well.  So I tried to keep in mind that I was undoubtedly reading a skewed sample of people.

But the many, many accounts of augmentation I read were truly horrific.  I read accounts of people who were living in agony—unable to sleep, unable even to sit down.  

And the worst part of augmentation seems to be that there is a way to manage it, but few doctors feel they are able to use this way.  Clinical Management, which is really the main authority for treating RLS, notes that the only way to manage the severe symptoms that usually happen with augmentation is to prescribe opioids until the DA is out of the patient’s systems and the severe symptoms abate.  However, it also notes that since some patients will experience augmentation on other DA’s, they may need to be maintained on a low dose of opioids indefinitely.
I am simplifying the treatment options recommended, but the short version is that opioids are probably going to be needed for at least part of the treatment, and for some patients may be the primary medication needed.

The problem is that many doctors are either unwilling, or unable, to prescribe opioids.  This leaves their patients in a horrible, never-never land.   They are worse off then they were when initially diagnosed and prescribed a DA, but can find no doctor willing to prescribe the only medication (opioids) that can now relieve their suffering. Return to top of page.

Chapter Two:  What To Do?

For my back pain, I decided to keep doing what I was doing:  exercises and visits to my chiropractor.  For the RLS, I decided to see a neurologist who specialized in the disorder to see if something treatable was causing my distress.  Maybe I had low iron or low vitamin D, and some iron infusions or more vitamin D tablets might be the answer.  Maybe I was developing diabetes, and that’s why the RLS had become so troublesome.  

The neurologist ran a whole series of tests, but they all came up negative.  My iron levels were good.  I had no peripheral neuropathy.  I didn’t have diabetes.  It seemed that, indeed, my RLS was primary.  He wrote me a prescription for a DA, and told me to check back in with him in a couple of months.

I put the prescription in a drawer, and thought about it.  I really, really, did not want to start down that road.  I was afraid of the side effects of the dopamine drugs and even more afraid of the possibility of augmentation.  

So I renewed my search online for something else that might work.  Some writers are adamant that inflammation causes RLS and chronic pain.  My primary care doctor tested levels of inflammation in me, and they were low.  I took every vitamin and mineral I could find that might help. I think some have helped a little—and I still take them—but essentially my RLS was still raging unchecked and my back and shoulder pain flared up much too often for my comfort.  Plus I was reading more and more research about how you shouldn’t take too much Advil.

One comment that came up again and again in the online forums was that many RLS sufferers saw a complete remission of their RLS symptoms when they were put on pain killers for another condition.   After back surgery, for example, they were put on Percocet for a bit, and noticed that not only did it help with back pain, they were completely free of RLS while on it. Kratom

This was very interesting, but prescription painkillers have been abused so much that the guidelines for prescribing them are now very strict.  Even Clinical Management, which notes how effective they are for even recalcitrant RLS, only recommends them as a last resort drug.   And most doctors won’t prescribe them at all for RLS.   I thought that perhaps I could get them prescribed for my back pain, but I understood that doctors were even becoming reluctant to do that.  Plus I had taken Vicodin after some surgery a few years earlier, and had hated the way it made me feel.

I live on the East Coast, and about this time was planning a trip to California to see one of my children.  I didn’t see how I could get through the flight without some kind of drug to manage the RLS.

But I really, really did not want to start taking the DA drug prescribed for me.  Should I go to my primary care doctor and try to get Codeine or Percocet, telling her it was for my back?  Certainly I did have back and shoulder pain too.  But I was afraid any of the prescription drugs would be as unpleasant to take as Vicodin was.

So I kept doing research, and eventually stumbled across a herb called Kratom.  Most of the information about it concerned its use with chronic pain—well, that was certainly me—but none suggested it was also good for RLS., and RLS was my major problem.  But it was a herb that had pain-relieving properties, and—unlike the prescription pain killers that I was afraid of—had a reputation for being gentle and essentially free of side effects.

Maybe I should explain here that, even though I came of age in the 1960’s, I’ve never used drugs.  LSD?  Angel Dust?  God no.  I’ve never even smoked marijuana—or even cigarettes.  I’ll have at the most one or two glasses of wine a week.  I had been doing everything I could for years to avoid using drugs for my back pain.   I just don’t use drugs.

But the RLS was becoming unbearable, and my back pain was becoming harder and harder to manage.  I had to do something.  I decided to investigate this gentle herb, kratom. Return to top of page.

Chapter Three:  What’s Kratom?

According to Wikipedia, kratom is an evergreen tree, native to Southeast Asia, whose leaves are used for medicinal purposes.  It goes on to say that “Kratom behaves as a μ-opioid receptor agonist like morphine and is used in the management of chronic pain, as well as recreationally.”

I found out, first of all, that it is legal in every state in the U.S. except Indiana [this has since changed as more states have made kratom illegal - check your local state laws].  However, recently the FDA announced to its field personnel that they could detain certain products containing kratom.  I haven’t been able to determine exactly why the FDA took this action.  I think it’s because they believe kratom has no acceptable medical or nutritional uses, but I’m not sure.  It may be because they are getting pressure from other sources.  

I also found out that occasionally there is a groundswell of political pressure to make kratom illegal.  Recently, Oklahoma, Arizona, and Illinois have all attempted to ban the herb, although it is looking more and more like the ban might only cover buyers who are under the age of 18—not a bad idea, I think.  It does seem ridiculous to me to try to make a mild herb illegal when we are finally getting sensible about marijuana.  

At any rate, kratom is still legal to use.  To be illegal, the FDA would have to classify it as a Schedule 1 drug.  And, although it seems like the FDA action, allowing it to be detained, would cut down the supply, it hasn’t appeared to do so.   Kratom is even sold on Amazon, although the word “kratom” is rarely used now. To see it on Amazon, you need to search by the type of kratom you want, rather than by the word “kratom.” 

So you can search for “maeng da” or even just “MD powder,” and  maeng da kratom will come up.  “White Borneo” will bring up White Borneo kratom on Amazon. And on the page where it lists what buyers of this product also bought, other types of kratom will be listed.  I won’t list all of the different types here;  I have attempted to do so in the Appendix.

Since the FDA was listing it as a drug of concern, one would think that there were many instances of severe problems caused by kratom, but I could find hardly any.  There are a few reported instances of kratom being implicated in the death of someone, usually a teenager who was using it to get high. But in every report I found, the teenager was taking other drugs with it. I haven’t yet seen a report where kratom is clearly the cause of death.  For example, this summer (Aug. 2014) a young man in Florida, Ian Maunter, committed suicide, and his mother blamed the suicide on his use of kratom.  But the young man had had problems for years, and was being treated for depression. It seems just as likely to me that depression caused the suicide.

By comparison, the Center for Disease Control and Prevention (CDC) estimates that excessive alcohol use leads to about 88,000 deaths every year, and cigarette smoking is responsible for one out of five deaths in the U.S. every year. And no one is talking about banning them. The CDC also reports that forty six people die each day from an overdose of prescription painkillers (like Percocet and Vicodin).   But since I don’t think our lawmakers always act rationally, I figured that—if I started using it--I needed to be prepared for the possibility the FDA would make it a Schedule I drug, a disturbing thought.  

The other disturbing thing about kratom is that I could find no good academic studies on it.  And because kratom has been studied very little, it’s hard to find out exactly what the effects of using it are.   I was dependent on personal Internet accounts for that, and what I found was encouraging.  The most troublesome side effect seems to be constipation, which is a common side effect in many painkillers.   The other side effects—nausea and headaches primarily—seem to occur when someone takes too much, or doesn’t drink enough fluids.

While it’s hard to find accounts of deleterious effects of kratom, stories of its benefits abound.  A Google search brought up over 200,000 entries.  The benefits claimed generally fall into one of two categories.

The first benefit claimed—and the one that people anxious to ban kratom always tout—is that it is a mood enhancer.  This is certainly the benefit that drives much of the Internet chat about it.  There are endless postings about how much kratom you need to take to get high, the best way to ingest it, etc.

There are some major drawbacks to using kratom as a mood enhancer, however.  For one thing, it is a very mild plant, which means people trying to get high need to take high doses of it.  While large doses of kratom don’t cause breathing difficulties, as opioids can, too much kratom can cause nausea and vomiting.  In addition, apparently one develops a tolerance to kratom when using it as a mood enhancer, and you have to keep increasing your doses to get the same effect.

I wasn’t interested in getting high, so the postings I searched out and read were those from people who used it to manage medical conditions.  There are also many, many of these.  The accounts I found were from people who used it to manage chronic pain, anxiety, depression, and withdrawal from other, harder drugs, such as prescription opioids, alcohol, and illegal narcotics, like heroin.

Here are a few of the comments:

In September, 2013, Ed Hoy posted this note on the Scientific American Site: http://www.scientificamerican.com/article/should-kratom-be-legal/#comments  

“I have used this natural unadulterated leaf for over 5 years to treat the pain and symptoms of diverticulitis, bulging discs, and degenerative disc disease. During this time, not only have my symptoms receded, but I have completely quit my dependence on pharmaceuticals like Vicodin, and Oxycodone. Prior to finding this plant, I was hopelessly dependent on opiates, which no longer even worked to alleviate my pain.

“Possibly related to Kratom is the fact that during this same time I have also quit smoking cigarettes, and cannabis. My alcohol consumption has also dropped significantly.   I do not experience any type of high from Kratom, and the amount that I take daily has not increased in 5 years.”

Wow, that was encouraging.  We have exactly the same back problems, and I even have diverticulosis as well.  A match!

On the same site, Tom Kray posted this note in July, 2014:

“I have suffered for a decade with severe chronic nerve pain as a result of a surgery complication. I spent years on legally prescribed opiates, neurontin, flexeril etc. while simultaneously getting nerve blocks and ablations of the damage nerve. I did acupuncture, active-release treatments, physical therapy and tried every other possible approved treatment but nothing worked. The way the medical community dealt with my chronic pain made my mind foggy, my body exhausted and my spirit crushed. The chronic pain destroyed my life and led to depression that was also treated with various medications. Kratom gave me my life back. It is a miracle plant . . . Kratom has not caused me any of the long list of side effects that the FDA approved medicines I was on clearly caused in me. No lethargy, no constipation, no foggy thinking.... nothing but feeling better. I believe it is safer than drinking coffee. Because of Kratom I have no need for any medications or treatments at all and have not taken anything else but Kratom for several years. . I feel better than I have ever felt. I am not in severe pain all day long like I was even when on opiates. My mind is clear and I have hope. I am not depressed anymore or having anxiety attacks from thinking about how much pain I will be in by the end of the day. I feel better, act better, look better and think better since I stopped taking FDA approved medicines and started using Kratom instead.”

Another site that had some interesting postings was this:

http://ww.naturalproductsinsider.com/news/2014/03/fda-states-mount-war-on-kratom.aspx#disqus_thread 

In August of 2014 Chris posted: “3 years ago, I began taking kratom 2 to 3 times daily for anxiety and depression after trying just about everything else and then drowning in sorrow, booze and low self-worth and all of that great stuff that comes with being a sad depressed bag. I've experienced no negative side effects whatsoever with kratom. I can even testify that kratom has not only helped me stop drinking but actually repelled me from it, and I honestly couldn't be happier!”
From the same site,  LJ_CO wrote this in June 2014: “I've used Kratom for going on 5 years now. Never had one issue or any flag in my blood work. As a matter of fact, my borderline high blood pressure dropped to near normal levels. I use it for anxiety and opiate cravings, thus keeping me off illegal opiates. This plant is a God send for many people.”

A Forbes writer, David DiSalvo, wrote an article somewhat critical of Kratom in September of 2012 here:  http://www.forbes.com/sites/daviddisalvo/2012/09/22/is-kratom-the-new-bath-salts-or-just-an-organic-pain-reliever-with-euphoric-effects/ 
He got eighty comments from that article, most of which, he reported, were supportive of Kratom.  Here are a few of the comments: Brent Amenell posted this: “As someone who has suffered with chronic pain for over 20 years, Kratom has been my miracle. I was tired of taking pills, fighting with doctors for pills, and all the bad things that come with pills. Kratom helps relieve my pain without all the side effects of the opiates. I can still function, and over time, I do not need to take more and more Kratom.”

Deborah Wertwijn’s comment (with typos corrected to make it more readable) is here: “Hi, I am using this for a year now, I was before using tramadol and oxycodone for the pain I have because I have Ehlers-Danlos syndrome.  Kratom is a very good painkiller for me.  I do not experience any withdrawal if I do not take it, as when I used the chemical painkillers I got really sick when I did not take them.  I do not feel sleepy or under drugs when I take kratom.  The only thing I experience is that the pain is much less, and the most wonderful thing is that when I started using kratom I had no withdrawal effects from stopping the tramadol and oxycodone.  I also take less anti depressive tablets now.  In my opinion the big pharmaceutical companies do not want us to use Kratom because than they will not make so much money anymore!”

SJCO’s comment:  “I have degenerative disc disease and sciatica that have been plaguing me since 2005. I had a 2-level spinal fusion surgery in 2006 which helped reduce the sciatica, but gave me new musculoskeletal pains in my lower back and hips. I have been on opiate therapy for my pain since 2005 and though I had managed to lower them considerably over the past year, I was still unhappy with taking such a high amount of opiates and Tylenol and knew that I had to switch to a safer alternative or risk having serious health issues from these medications as I aged. So I began using kratom on a daily basis and due to its excellent analgesic properties I was able to completely quit taking all RX’s for pain! It’s been a blessing for me and I have experienced no negative side effects at all since that time. I also have suffered with depression and anxiety for more than 15 years and have been on just about every medication made for both of those conditions and I find that kratom works wonders in both departments. I am no longer taking anything but kratom for pain, depression and anxiety and I’m so much healthier and happier for it! My wife also takes (a much smaller) amount of kratom daily as she suffers from chronic pain as well due to scoliosis. It helps her to relax, takes away her musculoskeletal pain, and seems so far to help keep her chronic migraines at bay.”

Reddit often has discussions of kratom use.  One of the most recent threads is about using kratom for dental pain:

http://www.reddit.com/r/kratom/comments/2edff8/extreme_tooth_pain_and_kratom/
Stronglikedan commented:  “I used kratom exclusively after my last root canal, and it worked very well. Since I take it daily, the antagonistic properties typically block the weaker narcos, like vicodin, anyway. With just the kratom, I went from a 5 to a 1 on the pain scale within an hour.”

There are many threads that deal with back pain.  Here is a typical comment at http://www.reddit.com/r/kratom/comments/26nys3/best_kratom_strain_for_back_pain/
Nursesati:  “When I messed up my back and was in terrible pain for almost four months, green Malaysian was my absolute go to. I tried other strains but always fell back to this strain. Not a big buzz or feeling, but the pain relief for me was wonderful. When I stopped taking vicodin after a few weeks, I was able to cope fine. Red vein thai is also good too.” Return to top of page.

Chapter Four:  Making a Decision

Kratom got such rave reviews from the medical users that I was tempted to order some immediately.  But I made myself consider both sides first.

I wasn’t too concerned about side effects.  The ones reported were mild, and I knew that anything I took would have side effects.  The ones reported for kratom were considerably milder than the possible side effects of the dopamine drugs or opioids.

My concern was the quality control issue.  How could I be sure that the kratom I ordered was safe?  I wasn’t going to be getting it in a sealed bottle.  It wasn’t approved by the FDA (au contraire).  Even if all of the reports about the wondrous properties of kratom were true, what assurance did I have that the kratom I ordered would be fresh and not mixed with some other, contaminated substances?
The answer, of course, is that I would have no assurance.  

But then I started thinking of all of the other produce I got that was unpackaged, and so could be contaminated.  Of course, U.S. inspectors occasionally inspect any produce being sold—but they surely don’t look at every leaf.  But just the fact that inspections are made gives one a certain peace of mind.

What keeps online stores—domestic or international—from ripping off customers is the fear of losing their good reputation.  I think the Internet has really helped here.  I was pretty sure that if some kratom vendor was selling stale or impure kratom, there would be messages about it all over reddit and other Internet sites that host discussions about drugs.  I felt a certain measure of safety when I realized that.

I also decided that I could minimize my risk by ordering from a site that had many products, not just kratom.  I would guess that they wouldn’t put their reputation at risk over a small part of their business. Finally, I decided I could look at the vendors who advertised on Amazon.  Surely Amazon would throw them off of their site if there was a hint that they were selling poor products.

The advantages to using kratom were easier to see.  

First of all, I liked the fact that I would be the one in control, not a doctor.  I could try to figure out a safe, effective dosage myself.  I wouldn’t have to count pills, worried that I lacked enough to get me through the month when I could get another prescription—if I could even get another prescription.

I liked the fact that kratom was a natural product, that had been used by people indigenous to Southeast Asia for centuries.

KratomSurely if there were some severe side effect it would have come to light by now.  Even in Thailand, one of the few countries where Kratom has been banned, the Thai Office of the Narcotics Control Board put out a report in 2010 saying that kratom had been banned for economic reasons, not health or social ones.  Apparently so many people were switching from opium to kratom that the government was losing much money from the opium trade:  simplest just to ban kratom—not that the ban has ever worked very well.

I liked that fact that, when kratom was used for a medical condition rather than for its euphoric properties, users didn’t seem to develop much of a tolerance.  Users coaching others on how to get high on Kratom recommend started with doses as high as ten grams, and then always talked about the near certainty of developing a tolerance as well.  Users looking to kratom for relief from a medical issue were coached to start with a low dose, of one to five grams. And many long-time users commented that they had never needed to increase their dose from their initial, fairly low starting dose.

This is unlike prescription opioids, for which patients often develop a tolerance. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628209/

Finally, of course, the possibility of using a natural herb that would take away my horrible compulsion to move my legs, as well as my chronic back and shoulder pain, was thrilling, to say the least.  If it worked, it would change my life.

I decided to give kratom a try.

I know this sounds like a reckless decision—to start ingesting a drug from Southeast Asia that had never been approved, or even tested, by our FDA.   I didn’t think my decision was a good one.  But at this point I felt like I had no good options. 

I had exhausted all nutritional and over the counter options.  I was very afraid of going on a dopamine agonsit (DA) drug.  I knew that no doctor would prescribe an opioid for me.  If I had already been on a DA drug, and gone through augmentation, that there was a slim chance a doctor might prescribe an opioid, but I didn’t want to go through the hell of augmentation.  Plus opioids carry their own risks and side effects.  I was also keeping in mind the Center for Disease Control (CDC) statistic that 15,000 people die yearly from an overdose of prescription pain medication.  Researchers are scrambling to find even one death that is clearly a result of taking kratom.

I’ve never looked upon using kratom as a good option, only a less bad option than all of the other available ones.  If a good cure for RLS and chronic back pain was discovered, I’d be thrilled to take advantage of it.  I’d drop kratom in a heartbeat. 

But meanwhile I had a cross-country flight coming up. Perhaps I could continue a while longer pacing the floor at night, but I didn’t’ see how I could bear the torture of a long airline flight again. I decided to take the plunge, and try this South Asian plant. Return to top of page.

Chapter Five:  Trying Kratom

I did an online search for Kratom vendors, found one, ordered a small amount with my credit card, and waited for delivery.  It never came.

That was how I found out about unreliable vendors.  I will say that since then, I have found the other vendors I dealt with to be extremely reliable.  But this was a bad start, and as a result, I left for California with nothing but my usual vitamins and supplements, and a large container of Advil for my back and shoulders.

The flights both ways were horrible.  I squirmed in my seat.  I hoped for long lines to form for the bathrooms, and immediately stood in them, to ease the squirmy feeling in my legs.   I loved long lines.  I counted the minutes, the hours, until we landed.  The Advil helped my back and shoulder pain, but did nothing for my RLS.

And the nights in California were not any better.  We stay in a short-term rental there, rather than with our son, so at least I could pace in the living room at night without disturbing anyone.

When I got home, and saw that I had a cross-country wedding to attend in another few months, I decided to try again to order some kratom.  This time I chose a vendor more wisely, Kratom Therapy, and in a few days received my order.

Medicinal Kratom is made by turning the leaves of the Kratom tree into a powder.  You can order this powder in capsules, or just by itself.  I started by ordering the capsules.

I ordered something called “Red Dragon” and the first night took two capsules.  They quieted my legs, and I fell asleep.  I woke up a couple of hours later and took two more capsules.  Again, after awhile my legs quieted, and I fell back asleep.

I followed this pattern for the next couple of weeks:  two capsules before bed, and then two more each time I woke up, which was usually two or three times a night.

Even though I was waking up, and often had to wait for the Kratom to take effect, I was piecing together around six hours of sleep a night.  Things were looking up!

I kept waiting to see if I developed any side effects, but I couldn’t feel any at all.  I didn’t feel high from the little amount I was using.  I wasn’t getting headaches.  I wasn’t constipated.  I never had the slightest “drugged” feeling.  If the kratom hadn’t been relieving the RLS, and my back and shoulder pain, I would have thought it was doing nothing.

My route to the wedding involved flying from the East Coast to California, and then to Reno, Nevada.   I took double my usual amount of kratom for the California flight, and took the capsules every two hours.  It was incredible.  I had no RLS symptoms at all.  In fact, the absence of symptoms made me so cocky that I took much less on the Reno flight, and was again miserable, since it takes a good half hour to forty-five minutes for the capsules to dissolve and the herb to become active.

But, at any rate, when I got back home, I saw that Amazon was now carrying Kratom, and decided to order through them, since I was sure they would only deal with trustworthy vendors. The Kratom Therapy store had been very reliable, but I couldn’t resist trying out the vendor I found on Amazon, Velvet Soul.  I also decided to try the powder rather than the capsules, as the powder would work more quickly.

I ordered a kratom strain called maeng da from Velvet Soul, and loved it.  I found that by mixing it with a little orange juice, the powder was easy to take, and worked much faster than the kratom in capsules.  Plus the maeng da seemed stronger than the Red Dragon, and seemed to last better at night.  I started using a half a tsp. of it every couple of hours at night, and had better control of my pain and RLS than I had had with the capsules of Red Dragon.

I used the maeng da for a couple of months when I noticed that constipation was becoming a real issue for me.  By then I had gotten in contact with another RLS sufferer who was using kratom, and she suggested I try the Red Leaf Borneo strain, as it was reputed to have the most pain-relieving properties, and to be the most sedating.  She also told me that it was not causing her any problems with constipation—or indeed, with any side effects at all.

I took her advice and switched to Red Leaf Borneo, still from Velvet Soul. With that, and the addition of a little extra magnesium, the constipation completely cleared up.  I was getting good relief from RLS and back pain without suffering any side effects at all.

I might mention that by this time Velvet Soul did not seem to be using Amazon anymore, so I ordered directly from their website without any problem, although, like Amazon, they avoided using the word “kratom.”  I had to search for “Red Leaf Borneo” to bring it up. I kept ordering from them because their kratom was so finely ground that it was almost a powder.  Also, on their site I could put my credit card in, whereas I had to call the credit card in on the Kratom Therapy site.  But both sites, I emphasize, were very professional.

At this point, I’ve been using kratom for almost two years, and I am still extremely happy with it.  I still have no side effects—no drugged feeling, no headaches, no nausea, no dizziness—none of the side effects often associated with pain killers.  It’s not perfect;  sometimes the back or shoulder pain breaks through.  Sometimes it doesn’t calm my legs.  I’m never sure if that’s because the pain or RLS is getting worse, or if I just need to take more kratom.  Taking more will usually bring relief.  Other days my legs are fairly calm, and I can use less than usual.

Sometimes I can figure out what causes good days and bad days.  Other times I have no idea.  But I am starting to relax about flying, and am starting even to enjoy flights.

This summer I started a trip by flying from Newark, NJ to Los Angeles.  It was an early morning flight, and I tool plenty of kratom, starting a few hours before the flight.  My back and shoulders, and my legs, were fine for the whole flight.  It was great.  The flight was crowded, but I had my seven-year-old grandson with me, and my kindle was loaded with books.  I had set up my iPad mini with games and movies for my grandson, and leaned back and had a lovely time reading on my Kindle.  No pain.  No squiggly feeling in my legs.  My charming grandson.  Who knew life could be so good on an airplane?

A week later I flew from Los Angeles to Honolulu, with my younger daughter and a three-year-old grandson.  Again, I took plenty of kratom, and so could enjoy reading on my kindle and watching my grandson play games and watch movies on my iPad.  Again:  an enjoyable flight!  This was such a new experience for me.
And then two weeks after that, my husband and I flew from Honolulu back to Newark.  Because of the six hour time difference, the only non-stop flights were overnight ones.

This was Mt. Everest.  A night-long flight of ten hours.  

KratomThe flight was due to depart at 8:05 p.m.  By six I had started taking two grams of kratom every hour.  Early evening is usually one of my worst times for RLS, and I was not optimistic. 

I felt fine until everyone was on board.  Then the RLS broke through the kratom.  I was trapped, couldn’t get up at all, as we were getting ready for takeoff.  I took another gram of kratom, waited about forty minutes, and then took one more grams.  Since I had to use capsules on the plane, and they take awhile to dissolve after I take them, I knew I wouldn’t feel their effect for another half hour or so.

But finally, just as the plane was lifting off, the kratom kicked in.  Heaven!  My legs completely calmed down, and stayed calm and comfortable for the whole flight. I had no back pain at all now, and no shoulder pain. Ten hours.  All night!  And I read, and dozed, and watched a couple of movies.  No problems at all!

I don’t know how much I took for that flight, as I had decided I wouldn’t keep track, but take what I needed to be comfortable.  But I think I took somewhere around ten grams—a huge amount for me. 

After that flight—a ten-hour overnight flight—I knew that, with kratom, I could go anywhere. Return to top of page.

Chapter Six:  The Nuts and Bolts

How Much to Take 

I’m a small, elderly woman who weighs only a hundred and thirty pounds.  So while one gram may be a big enough dose for me, larger, younger people will probably need more.  The advice I read on Internet accounts over and over again is that you should start small.  One teaspoon is about two grams, and I think for most people that is plenty for a starting dose.  If you’re smaller, than try a half a teaspoon, or a gram.  You can always take more.  But wait at least an hour before you decide that you haven’t taken enough. Return to top of page.

How to Take It

The Internet is full of advice for ways to take kratom, usually given by users who are trying to take a large dose and get high.  They recommend something they call “toss and wash.”  Apparently, this involves first taking a mouthful of water, and then adding the kratom to it.  You swish the stuff around in your mouth and then swallow.

The problem with this is that users are always complaining that the kratom tastes terrible.  Some people remark they usually throw up a bit.

That all sounds horrible to me—and I’m afraid I’d choke with all of that in my mouth.  So here is how I do it:

I measure a dose—usually half a teaspoon—of the kratom powder, and dump it into a little cup.  I use the small, plastic jello cups I order from Amazon.  Then I add orange juice, and let the mixture sit in the refrigerator for at least twenty minutes.  That gives the kratom a chance to dissolve, and the mixture is very easy to swallow.  Plus it doesn’t even taste bad.

I usually make up five or six of these cups every day, and keep them on a tray in the refrigerator, so one is ready when I need it.  Of course, if kratom would just develop a time-released leaf, I wouldn’t need to take it so often.  But I’m not optimistic.

I know lots of other people make a tea with it, but since I am usually using it in the middle of the night, I don’t want to fuss with tea.  But apparently, they use the kratom as tea leaves.  Their advice is to let it steep for twenty minutes, and then strain it and discard the leaves.

Sometimes capsules are the most convenient way to take kratom.  Certainly it’s what I need when I’m out of the house. There are a couple of gadgets that help you make up capsules of kratom with the powder you have.  They are pretty cheap.

Again, I got one on Amazon, and I think they have various models for around twenty dollars.  I keep about fifty capsules in the refrigerator, ready to take with me.  Making up your own capsules is much cheaper—and I think the kratom is fresher—than depending on ones a vender makes up. 

So when my capsules are getting low, I set up the little capsule-making gadget, put on a video, and start stuffing capsules.  With the little gadget it’s very easy.  I can usually make up a couple of hundred capsules during one video. Return to top of page.

How Often to Take Kratom

It’s funny, but when I have to take it during the day (unless I’m flying, when all bets are off) a half of a teaspoon will last four or five hours.  If I want to sit and read in the afternoon, I have to take a little kratom to be comfortable.  So I may take some about 3:30.  Then I’m usually perfectly comfortable until around eight at night.

But at night, when RLS symptoms are always much worse, a dose will often last only two hours.  And just lately I’ve started keeping a cup with orange juice and a whole teaspoon which I used at night when the symptoms are the worst.

Generally, I’ve found that when I’m in a situation where I know the RLS will be acting up, it’s best to start taking the kratom early.  So I begin taking some now at least two hours before something stressful is coming up, like an evening show or long car ride.  Even if my legs are feeling okay at the moment—and I have the capsules and water in my purse so I can take it anywhere—I’ve found it’s better to start early.  The capsules take awhile to dissolve, and once the pain, or RLS symptoms, get established, it’s harder to control them. Return to top of page.

Storing Kratom

This is one area where there seems to be general agreement.  Kratom should be stored in a cool, dark place.  It’s a leaf, after all.  I store mine in the refrigerator.  If you’re storing some for a long time, and can seal it into an airtight bag, some people recommend the freezer.

Water

It’s hard to emphasize this enough.  You need to drink lots of water when taking kratom.  Otherwise, your mouth will get so dry that you’ll have trouble swallowing, and I have seen some indications in postings that that you might be susceptible to liver damage.  There hasn’t been any research on this, that I could find, but it’s better to be safe than sorry.  Take small doses and drink plenty of water.

Activities

Driving:  I haven’t found any need to restrict my driving.  If anything, kratom seems to give me more energy and make me more alert. I won’t drive anymore after even one glass of wine.  But kratom doesn’t seem to affect me at all—except to manage my pain and RLS discomfort.  In fact, if I’m driving long distances or if it’s late in the day, I feel safer if I take a small dose of kratom first.  Driving with active restless legs, or bad back or shoulder pain, does seem dangerous to me.  I just can’t emphasize enough how little a small dose of kratom affects anything but my pain and restless legs symptoms.

Exercise:  The big drawback to kratom—chronic pain-wise—is that kratom is taking care of my back pain so well that I’m finding it very easy to skip my back and shoulder exercises. I know that kratom just gives me symptomatic relief.  I know that I need to exercise to help my muscles be strong and flexible.  And so I do.  But, honestly, I do think kratom makes it a little harder.  Before kratom, I knew I absolutely had to exercise every day.

Reading:  I feel like kratom has given me back books.  I used to love to read in the late afternoon and evening, but was usually too uncomfortable to manage it.  Now, with a small dose of kratom, I can curl up with a book and be perfectly comfortable. 

Little Chores:  Because when I take kratom in juice, it usually takes fifteen or twenty minutes to kick in, I find that’s the perfect time to do little household chores.  So I’m great now about emptying the dishwasher, putting away laundry, doing a little sewing, making beds—all of the little chores that it’s so easy to ignore.  Before kratom, I used to be in despair so much, feeling that I would never feel better, that it was hard to get motivated to do anything.  Now I know that wonderful little herb is going to get active very soon, so I might was well use the time waiting to get something useful done.  A funny, unexpected side-effect.

Withdrawal 

I haven’t experienced withdrawal because I haven’t skipped a day since I started taking it.  But I don’t think I’m addicted, at least not in the usual sense.  I don’t crave it.  I crave the freedom from RLS and chronic pain.  That’s all.

Even though I haven’t withdrawn from it, the Internet has plenty of stories of what happens when you stop taking it.  Generally, it seems, when people stop after taking doses as low as mine, there are few, if any, withdrawal symptoms.  In fact, a comment I’ve read again and again, is that it was harder to get off of coffee than it is to stop taking kratom.   People who take large doses to get the euphoric effect report stronger opioid-like withdrawal symptoms, but many people who have also withdrawn from opioids, report that the kratom withdrawal is quite mild compared to that.  In fact, I’ve read lots of postings by former addicts who used kratom to manage their withdrawal  from opioids, or even heroin.  But, like I say, I don’t know.  This is just what I’ve read.  I’ve had no personal experience of withdrawal. Return to top of page.

Research

Talking about kratom research reminds me of the year Irish cookbooks were prominently displayed in stores, but when you opened them up, the pages were blank.  I guess the Irish are not famous for their cuisine.

Well, I don’t see any pages dedicated to kratom research either.  Occasionally something pops up.  When I do an Internet search, a 1975 study of kratom users in Thiland appears.  Here is the link to it:

https://www.erowid.org/plants/kratom/kratom_journal3.shtml. 

And this is the study that is most often referred to.

The study consisted of interviews with thirty subjects.  All but five had used the leaf for over five years, and one had used it for thirty years.  There didn’t seem to be any effort to determine exactly how much kratom each subject commonly used.  But the study reported that long-time users had darker skin and were thinner.  Some developed insomnia.   Some developed constipation.  Five seemed to have developed what the researchers called “kratom psychosis.”  But in four of these cases, the men (they were all men) were taking hard drugs, like heroin, along with the kratom.  One was using a lot of alcohol as well.  So it seemed a stretch to me to blame their psychological problems on kratom.

What I found interesting was that most of the subjects interviewed said that kratom helped them be “happy, strong, and active.”  It motivated them to work in the rice fields or their own garden plots.

I thought this was very interesting, since most drugs seem to pull people out of society and work.

But it was a very sketchy study, and it’s the only one I could find.  And I didn’t see any reports in it of people dying from overdoses.   The Kratom Association (http:// www.kratomassociation.org/publications/kratom-research) lists several more studies on their website.  All of these, from what I could tell, were preformed on rodents.  I had a hard time figuring out exactly what they showed, although the one thing that popped up was kratom seemed to suppress weight gain in the rodents.  And it did not cause deaths.  But I couldn’t tell if kratom did anything for chronic pain in rats, or for stress, or for restless legs syndrome.   I don’t even know if rats suffer from RLS.  How could you know?  Do some pace more at night?  And stress?  Do rodents suffer from stress?

At any rate, I didn’t find those studies very helpful.  I do wish some researchers would do some solid research on Kratom.

Supplements:

Since I’m not sure how much supplements are contributing to my success with kratom, I thought I’d say a bit about them.

I’ve taken Co-Q10 for years, ever since I was put on a statin drug and promptly got a massive case of shingles.  So no more statins for me, and no more shingles.  But I’ve kept taking the Co-Q10.

I take a variety of vitamin, and I switch them around every so often.  But mostly I take the usual:  viatamin D, the B vitamins, some vitamin C etc.

At night I take two magnesium pills and two 100 mg. pills of l-theanine, which is apparently some green tea derivative.   But the l-theanine seems to help me sleep.
Sometimes at night, if I’m feeling very restless, I’ll take some D-ribose.  It’s a powder and I drop it in my cup of orange juice and kratom.  I take it because another one of the theories about kratom is that the sufferers have too much glutamate in their brain, and this is responsible for the hyper-alert feeling that often accompanies the leg symptoms.  In fact, the Johns Hopkins Center for Restless Legs Syndrome is doing a study on levels of glutamate in RLS suffers right now.  

Usually the kratom will completely take care of my RLS and pain symptoms.  But some nights I still have a restless feeling and am unable to sleep, and I’m thinking that Johns Hopkins is right, and I have too much glutamate.  I certainly have what the study describes as a hyper alert feeling.  So I studied up on glutamate and found that it was a neurotransmitter and that another neurotransmitter, adenosine, helped control it.  Adenosine, I then found out, attached itself to a ribose sugar molecule.  So I take some D-ribose.  It often seems to help.

Finally

I just want to emphasize again that I’m not a doctor or a medical researcher.  I’m just a chronic pain and RLS sufferer.  I devoutly wish that there were good, available treatments available for chronic pain and RLS.  

But it seemed to me that the side effects, or long-term effects, or difficulty getting prescriptions make the standard treatments for these conditions problematic.  At least they did for me.  That’s why I decided to try an unknown plant, that was far outside of my comfort zone.  I’ve never looked at kratom as a good option—only a less-bad option.

So far, it works very well for me.  Even on the nights when the hyper-alert aspect of RLS is overwhelming any sleep I can get, at least the kratom makes my legs calm, and my back pain-free.  I can lie quietly in bed, reading or listing to the radio.  And then I eventually do go to sleep. Return to top of page.

Appendix

Types of Kratom: I am just listing the different kinds I see described on various Internet sites.  I have no idea if this is a complete, or even accurate, list.  I don’t know where such a list would be found.  So you can look at this list as a start—to give you some idea of the varieties of Kratom.

Kratom Online lists these strains, on http://kratomonline.org/types-of-kratom/.  On the site is also listed the supposed properties and strength of each kind, which I won’t replicate here because I have no idea whether or not the properties are accurate.  Many online kratom stores offer sample packages that a little of several strains.  My advice would be to order a sample package and see what kind works for you. Bali Red Vein Thai Red Vein Thai Green Vein Malay Green Vein Borneo White Vein Maeng Da White Vein

Kratom Science offers another list, on http://www.kratomscience.com/strains-effects-and-dosage/.  Most are similar to the Kratom Online list, with these additions: Ultra Enhance Indo Thai Essence Super Green Malaysian

Online Kratom has yet another list at http://www.onlinekratom.com/kratom-information/kratom-strains.  Again, there is some overlap, although the site tends to throw all of the kratom from one country into one list item.  Like this: Malaysian Kratom Indonesian Kratom Red Vein Borneo (Finally, my favorite!) Maeng Da Kratom (which they charmingly nickname “Pimps grade”). Some sites offer a kratom tincture.  A tincture is made when some of the leaf is dissolved in alcohol.  Apparently the resulting product is very strong.  I haven’t tried a tincture yet, nor do I intend to.

Where to Buy Kratom:

Since my efforts to buy kratom initially resulted in my being ripped off by a site (whose name I truly can’t remember), I am reluctant to recommend any site myself that I haven’t used.  The two I have used are Kratom Therapy

(https://www.kratomtherapy.com/)

and Velvet Soul Naturals (http://www.velvetsoulnaturals.com/).  I recommend both of these.

The best online list I found of recommended stores and reviews are here, at Kratom Online (http://kratomonline.org/category/reviews/).  

The other thing to do is to go to Amazon, and put in the names of various strains, and see what stores are selling them. I will say that there is almost universal agreement not to buy kratom locally, in head shops or gas stations.  Most online posters assert that kratom bought that way is more expensive, and more likely to be poor quality.  

I’m sorry I’m not more help with good kratom vendors.  I just really don’t want to recommend a store that I’ve had no personal dealings with.

Yes, I know:  I’m not much help in this appendix.  I’m sorry.  Maybe if some researchers would start examining this drug—and if the FDA would approve it—we could come up with a list of different strains and what they do, as well as a good list of the best places to buy it.  Meanwhile, we sufferers of chronic pain and restless leg syndrome muddle along as best we can.

Return to top of page.

And kratom, for me, has been an amazing help.  Thanks for reading.

[This book can be purchased on Amazon as a Kindle book.]