Archive for the ‘obsession’ Category

ADHD, Obesity, and Chronic Pain, Correlations and Causation!

July 2, 2012

 

Subjective Pain Measurement Scale

I apologize for the length and complexity of this discussion, but there is very little in the scientific Literature that studied ADD/ADHD and Chronic Pain. All I could find was one technical article, yet if you go to the bulletin boards and forums, there are many individuals begging for help. Just as obesity programs fail for those with ADD/ADHD, I suspect that Chronic Pain Treatments will be difficult for this unique subgroup with out working to resolve all three issues, ADHD, Obesity, and Chronic Pain.

Science Daily reported “A clear association between obesity and pain — with higher rates of pain identified in the heaviest individuals — was found in a study of more than one million Americans published January 19 in the online edition of Obesity. In “Obesity and Pain Are Associated in the United States,” Stony Brook University researchers Arthur A. Stone, Ph.D., and Joan E. Broderick, Ph.D. report this finding based on their analysis of 1,010,762 respondents surveyed via telephone interview by the Gallop Organization between 2008 and 2010.

Now from a marketing perspective, telephone surveys have the greatest incidence of error and this may account for the lower National rate of obesity reported in the study with only 28% claiming a height and weight indicating obesity.  Now without interviewing people in person or providing extensive education on the happy face pain scale, I am not certain how they reached the conclusion that “finding suggests that obesity alone may cause pain, aside from the presence of painful diseases [associated with obesity]”

“Interestingly, the pain that obese individuals reported was not driven exclusively by musculoskeletal pain, a type of pain that individuals carrying excess weight might typically experience.”

“Drs. Broderick and Stone also suggest that there could be several plausible explanations for the close obesity/pain relationship. These include the possibility that having excess fat in the body triggers complex physiological processes that result in inflammation and pain; depression, often experienced by obese individuals, is also linked to pain; and medical conditions that cause pain, such as arthritis, might result in reduced levels of exercise thereby resulting in weight gain. The researchers also indicated that the study showed as people get older, excess weight is associated with even more pain, which suggests a developmental process.”

Now the implication is clear, lose weight, grow younger and all your aches and pains will disappear. But the underlying assumption, the so called jump from conjecture to conclusion, is that obesity causes pain in some yet to be discovered but currently unknown ” complex physiological processes.” That does not sound like a true scientific explanation but more like junk science at it’s worse.

In a very well researched paper by E. Amy Janke, PhD;Allison Collins, PhD;and Andrea T. Kozak, PhD entitled “Overview of the relationship between pain and obesity: What do we know? Where do we go next?” the authors point out that there are many different types of pain including lower back pain, lower joint pain and generalized pain and their is no simple direct relationship between weight loss and reduced pain.

They summarize dozens of studies and a sample is presented below and represents both a lack of improvement for some pain and for others dramatic and lasting improvement especially for pain in the lower limbs.

In general, “Few studies examine both pain and weight as primary outcomes, and variability in measurement makes comparisons and conclusions difficult… Methodological differences among studies make conclusions about the influence of weight loss treatment on pain tentative at best. One issue relates to the samples used in the research. Samples in the reviewed studies represented potentially very different populations, thus making comparisons across studies difficult. Whereas some  researchers recruited based on overweight/obesity status, others selected individuals based on type or severity of pain condition in addition to weight.

They mention one, “early review of seven studies, found no evidence to support the recommendation of weight loss to treat Lower Back Pain [LBP.]

They ask, “How can we know so much about overweight/obesity and LBP and still know so little?  One answer to this question is that perhaps the relationship between the two is much weaker than previously hypothesized. A direct causal relationship between weight and LBP may or may not exist; indeed Leboeuf-Yde et al.’s meta-analysis certainly suggests that the relationship, if present, is weak

On the other hand, “Being overweight is a risk factor for development and progression of Osteoarthritis [OA] in the knee and hip, and possibly development of OA in the hand.  Weight loss is recommended for overweight persons with OA. Even being slightly overweight may increase your risk for developing knee OA.”

“However, other studies that have examined lifestyle interventions, such as enrollment in Weight Watchers and increased physical activity, traditional aerobic activity versus lifestyle physical activity, and diet and exercise treatment versus control,found no significant effect on bodily pain sub-scale scores despite significant improvements in physical functioning.”

In still another study, “Although the diet only group experienced greater weight loss compared with the healthy lifestyle group, no pain-related improvement was evident. In the exercise-only group, the only significant improvement was in mobility. However, the diet and exercise group had significant improvement in physical functioning, self-reported pain, mobility, and weight.”

Similarly another study “found that without exercise, weight loss alone did not lead to significant improvement in pain or mobility among overweight/obese individuals with knee OA”

In a different cited study, “the treatment group evidenced improvement in several aspects of Quality of Life and maintained an average weight loss of 13.9 percent of baseline weight. Improvement in bodily pain was only temporary and no longer evident at 4-month follow-up.”

Clearly the results bounce all over the place between some improvement and no improvement at all. In a very unique manner, there is no discussion of ADHD in any of the studies despite the fact that one third of Obese people suffer from ADHD and the greater the obesity, the greater the chance that the person also has ADD/ADHD.

But some times practitioners and researchers really do get it right. In a 2006, paper by Michael S. Kaplan and Leah R. Kaplan, entitled Why Do Chronic Pain Patients Have Multiple Accidents?, the authors explored the relationship between ADHD and Chronic Pain. The underlying assumption is that people with more physical trauma events have more chronic pain.

According to their paper, “A retrospective review of 460 random patients during a 6-month period included new and existing chronic pain patients. Our results preliminarily identified a trend in patient’s histories, characterized by anxiety problems and depressive symptoms, coupled with a family history of ADHD… The preliminary data support the hypothesis that chronic pain patients have a greater incidence of ADHD than might be expected and more importantly. We do not believe there are any previously published reports suggesting a correlation of ADHD with chronic pain resulting from increase incidence of accidents.”

There is ample evidence linking ADHD to obesity by people self medicating with food to elevate their dopamine levels and have their minds work in a normal manner and trauma links ADHD to chronic pain. but there is more to the relationship than that.

Recent research has documented the devastating effect that Chronic Pain has on the brain of a healthy person. For those suffering Chronic pain which had lasted six months or more, “researchers found abnormal brain activity during an attention-demanding cognitive task. They also found one region of the brain, was thinner in those with chronic pain compared to the healthy patients. This area of the brain plays a key role in mood, social judgment, short-term memory and higher-order thinking.

After the patients had corrective surgery for their medical conditions, the group of pain researchers from McGill University and the McGill University Health Center found that relieving pain actually causes physical brain changes they can see on a brain scan. During the cognitive test, the differences that the researchers had observed in brain activation in the first round of tests disappeared for eleven people in the group who had successful surgery. . Three of the 14 treated patients after treatment reported worse back pain or disability six months later. When researchers looked at their brain scans, their gray matter had not regenerated itself at all.

“Our results imply that [successfully] treating chronic back pain can restore normal brain function,” the authors conclude in their study, which appears in the Journal of Neuroscience.

In an article on Rewiring the Brain to Ease Pain in the Wall Street Journal,  Sean Mackey, chief of the division of pain management at Stanford, and his colleagues were just awarded a $9 million grant to study mind-based therapies for chronic low back pain from the government’s National Center for Complementary and Alternative Medicine  Some 116 million American adults—one-third of the population—struggle with chronic pain, and many are inadequately treated, according to a report by the Institute of Medicine in July.

According to the article, “one of Dr. Mackey’s favorite pain-relieving techniques is love. He and colleagues recruited 15 Stanford undergraduates and had them bring in photos of their beloved and another friend. Then he scanned their brains while applying pain stimuli from a hot probe. On average, the subject reported feeling 44% less pain while focusing on their loved one than on their friend. Brain images showed they had strong activity in the nucleus accumbens, an area deep in the brain involved with dopamine and reward circuits.

So research has finally come full circle and linked ADHD, Obesity and Chronic Pain. The same rewards that ADD/ADHD sufferers developed to stimulate dopamine production when self-medicating to think normally and function in our modern world are the same rewards that can be used to self medicate and mitigate the damaging effects of Chronic Pain.  Somehow, that result doesn’t surprise me.

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Growing out of ADHD: An Erroneous Concept

June 24, 2012

I am pretty much intolerant of junk science, shoddy research and uninformed opinions expressed as fact. Since the web is a total democracy, the banal comments following a well researched intelligent discussion on CNN or other well researched sites drive me nuts because everybody treats them as equally important to the main article and in a web democracy, everybody’s point of view is important even if it is ill informed and the person is a 17 year old cyber bully. However, that mini-rant is not the subject of today’s post.

While researching the current narrow topic of sexual addiction and ADHD, I was delighted to find a paper entitled  “Sexual Addiction and ADHD: Is There A Connection?” by Richard Blankenship and Mark Laaser published in 2004. This paper does an extensive review of scientific studies on the impact of ADHD on victims and the areas where scientific research is flawed or lacking. I believe that every person who has ADHD above the age of reason, every adult with ADHD and every person who has a child with ADHD should read this paper.

Unbelievable as it may seem to many this paper was written by two devout Christians. Blankenship is Director of North Atlanta Center for Christian Counseling, and Vice President of American Association of Certified Christian Sexual Addiction Specialists. Laaser is Director of Faithful and True Ministries, Bethesda Workshops, and President of American Association of Certified Christian Sexual Addiction Specialists. Seems ADHD is not just a problem with poor people who eat nasty food and bad parents, it crosses all socioeconomic and spiritual boundaries.

Of course one of the most comforting pieces of research relates ADHD with above average intelligence, but I already intuitively knew that. Thus, it agrees with my unscientific assessment of me, my family and my friends all peas in the same Mendelian pod.

The slightly less comforting assessment is that ADHD is a chronic lifelong condition which is under treated resulting in a huge loss in adult potential. From their paper:

ADHD if left untreated will metastasize into other disorders. ADHD untreated has been known to become conduct disorder in adolescence and antisocial personality disorder in adult years (Gresham, Lane, & Lambros, 2000). Left untreated, ADHD can also develop into substance and behavioral addictions. A Utah study revealed that 24% of male inmates had ADHD. Other studies have shown that up to 40% of people in minimum security prisons have disorders on the ADHD spectrum (McCallon, 1998).

Perhaps no study has revealed the magnitude of treating ADHD along with co-occurring disorders than that of Dr. Paul Wender. Wender was establishing through his study that ADHD is a lifelong condition and people do not outgrow it. In his study, when inmates were paroled they entered a program for a period of 6 months to 2 years. They were given medication and placed under the care of counselors, doctors, and support groups. National recidivism rates for people released from prison are approximately 60%. The inmates in this study had a two year recidivism rate of only 10%. Only one individual in the study had a new criminal charge while a few had parole violations. Many of these men had been diagnosed as children with ADHD but treatment did not continue past grade school years.

Some were told that they would outgrow ADHD after the teen years. None were being treated into their 20’s. 18% had discovered crystal meth from the meth labs that now exist in abundance. The methamphetamine had given them the ability to remain calm and focused. 20% were medicating with marijuana and heroin. More severe discipline will not change ADHD.

The guilt and shame families feel as they visit relatives in prison is incredible. Way too many were advised by people in the school system, counseling, and psychiatry that ADHD was a condition they would outgrow. Or, in the words of Dr. McCallon, medical director in the Colorado department of corrections “if he outgrew it, what is he doing in my prison?”

I know I couldn’t have said it any better even though I took the liberty of breaking this up in to shorter paragraphs so those with ADHD could take the time to read it.

Sex and ADHD: Part 1, Ranking my Obsessions!

June 23, 2012

Pretty much I accept that the cause of obesity from ADHD is direct. MRI studies show a decrease in dopamine in the brain for people with ADHD. Prescribed stimulants increase dopamine, but for those who never were treated or diagnosed with the disease, there are other ways to self medicate and increase dopamine levels. Sex, eating, taking risks, exercising or achieving goals all increase dopamine. Alcohol, cocaine, nicotine and other addictive substances have a remarkable ability to elevate levels of dopamine. Falling in love, buying lottery tickets, eating chocolate also increase dopamine. We get a much bigger blast of dopamine eating high-calorie foods than we do low-calorie foods.

If I had to rank my obsessions in order, my choices would be difficult because some obsessions seem to always be able to top other obsessions in my body and depending on  factors, some rise and fall on the list.  I have self medicated over a lifetime and have serious long term and short term obsessions. The only addiction that I really believe I encountered is cigarettes as there was no such concept as controlled usage which I believe I have mastered with food and alcohol. Since I quit smoking in 1984, I will rank my current obsessions in the order that they have guided my life and indulging in them gave me the ability to focus, preform well in society and control my ADHD without medication.

Family Love: I learned about the love of family from my mother. She had four children and was devoted to them. My father had his problems which he self medicated with Valium and Alcohol and did the best he could with family love but was simply not as active. 

Romantic love: My wife suffered a lifetime of depression but there was far more good than bad. When she occasionally made poor decisions, I deleted them from my official vision and lived with my perfect romantic image of her which was still true the majority of the time.

Sex: During some periods in our marriage, my wife would lose all interest in sex with me and rather than wander and cause disruptive problems, I suppressed my sexual desires while there were children in the house and focused on the love of my family and my image of our Romantic Love. The power of sex over everything below it on this list, was covered in my First Fat Savage blog which was obsessed in a crude way with losing weight because I was too obese to engage in sex and wanted that part of my life back.

Eating: This is the first of my obsessions which had a negative impact on my body, if I am allowed to ignore a few STD’s among close friends. Actually, it is this obsessive crutch which allowed me to get focused and organized and make a pretty decent living and be a pillar of my community for 40 years.  In my second Fat Savage Blog, which I have not yet organized for publication, I learned to control the timing of my meals and what I ate, in order to balance mid-range obesity  with my sexual performance, ability to do physical labor and mandatory office time. The next two obsessions can temporarily suppress my eating but I am lucky to find many goals or risks that obsessively possess me for any length of time.

Achieving Goals:  Every now and again, an almost impossible intellectual challenge comes into my life and I become obsessed with the solution. On the few occasions this occurred, the goal becomes more important than everything except family love, but once accomplished the goal was forgotten and there was no afterglow of success as there is with food, sex and my vision of romantic love.

Taking Risks:  Taking risks is low on the list because my family loves adventures and risk taking so these turn out to be great adventures where everybody has fun, socializes and gets their adrenalin flowing. The same is true of starting a business ,investing in the stock market and other financial risks which always get the family involved. There is no such thing as a solitary risk in our family.

Purpose driven manual labor (Goal Driven): This is on parity with Alcohol but occurs earlier in the day when I am programmed not to drink. The harder I work to finish a project in my house or yard, the more tired I am and the more likely to go to sleep and feel less of a need for alcohol.

Alcohol: My bottle of wine every night has elements of both social crutch and sedative. In terms of a sedative, I have never been able to beat the narcotic effect on my body after the first two glasses, and I don’t enjoy socializing and banal conversation without those two glasses. I have always recognized that when I drink a bottle of wine I will pass out within the hour and sleep soundly for the next eight to ten hours.  If I don’t drink a glass or two of wine at a party, i will go find something beautiful to stare at and ignore every living person at the party. If I drink the whole bottle and my wife was having a good time, I would find some place and go to sleep until she was ready to go. I don’t fight, argue, drive fast, chase women, have sex, say rude things or swear when drinking, I do that when sober.

Exercising: I really don’t like exercise where I have to go at fixed times to a gym or act like a hamster on a treadmill in a cage.  I would rather find something productive to do and go do it but since that is so low on my list of obsessions, it doesn’t make the cut very often. Still, when enraged in a situation with no answer, I find it easier to walk home six miles than to either drink or drive both of which I enjoy and which I do  not consider mutually exclusive. Finally, I developed “Walking with Wonder” and exercise is part of my new lifestyle.  Still, hardly an obsession.

Driving Fast Cars:  I have had a Toyota MR-2 which takes some skill to drive especially with big winds coming at you and potholes. I know for a fact it will start to go airborne where you lose all control at a combined speed and headwind speed of about 100 MPH especially if you hit  a bump or pot hole the wrong way. My fastest driving is during the day and after my two glasses of wine while socializing, I go home have a couple more and go to sleep. There is a thrill in being able to control a dangerous beast.

Eating Candy especially chocolate: I haven’t quit nor do I believe that I have been on my last binge. I still gain from one candy bar in some circumstances, but there is no benefit at all from binging, but what the hell, it’s an obsession.

Buying Lottery Tickets:  Playing the lottery is a fools game for the math challenged and at one level I know this. On occasion when I am poor, I get obsessed with spending my last $500 on tickets.  When challenged by friends and family, I point out that from Dante’s Inferno, the sign over the portal to hell is “Ye who enter here,give up all hope.” and in my mind, False hope is better than no hope. If you don’t play, you can’t win so you have no hope at all and you are living in hell. If I have quit, it will have been last week, probably because I have no more money.

Marijuana: Quit in 1971 the day my son was born without concern and have been around people who smoked ever since with no temptation. Contrary to most medical reports, I smoked because it kept me awake and allowed me to drink for a longer period of time in social gatherings without falling asleep.

Dangerous Obsessions that caused actual withdraw:

Nicotine: Quit in 1984, worthless addiction that when continued prevents the pain of withdrawal. Very serious withdrawal symptoms which lasted three to six months with several close calls to relapse and flashbacks for years.  I could only do it for love of my daughter.

Caffeine: Coffee in very small amounts had been my friend, however, too easy to increase the quantity in social gatherings and large amounts ruin my day.  Serious short term withdrawal symptoms for one week, with no flash backs. I quit for love of my mind.

I am amazed that Religion did not make the list of items that raise dopamine level because 50 years ago before being kicked out of church for heretical beliefs, I would have included it well above the middle, well maybe not higher than alcohol because I had started drinking a few years before and was discovering my limits at that time.

Sugar, Me and ADHD; Part 2

June 13, 2012

Sugar is both my friend and enemy and like many other foods, sugar has many different forms and all effect me slightly differently depending on the form. On the positive side, one chocolate covered peanut M&M’s, regular M&M’s, Hershey’s Chocolate Bar, or one of anything in this type of candy can be a tremendous physical or mental stimulant for a quick energy rush.

I always take a couple of candy bars along on my most grueling hikes with tourists and I usually have a candy bar when the hardest part has been reached and the rest of the hike is easier. I get re-energized and always offer some to the others in the group. Usually, people who are slim and in shape decline. However, I am constantly amazed at the positive therapeutic effect it has on those who are a little overweight and out of shape. They too get re-energized and happily finish the walk. I think they are happy to have me, as a thin fit person, share their passion for candy.

At the other extreme are the sweet candies like hard butterscotch or sour balls and the soft jelly candy like orange slices, cherry slices, gummy bears, sour worms and skittles. These are extremely dangerous when they are sold in large bags at low prices, usually six to ten portions in a bag or somewheres around 900 to 1500 calories per bag. They are pretty much pure sugar with a little color and flavor added.  The other dangerous items are boxes of malt balls (700 calories) or Girl Scout Cookies about 1000 calories a box or more.

Now what causes my binge eating of candy?

There is only one answer and that’s availability. Candy bars are sold in 200 calorie units and I have programmed myself to buy just one so there is no problem. When it comes to the second group and without much forethought, I continue eating the sweets until they are all gone. It usually takes less than an hour.

Initially, there is a feeling of childlike euphoria where I am “happy as a kid eating candy.” This moves beyond euphoria to a real sugar rush, almost like an adrenaline flow, where my blood pressure and heart rate both go up. Eventually there is a return to normal where I get very drowsy and irritable and some might even say argumentative.  I am now down 90 pounds from my peak but old habits die hard. I have probably had five or six sugar binge episodes in the past year. I have learned to pretty much avoid them at home by not buying more than a candy bar for any reason. However, on two occasions, the price of gummy candy got so low that I just couldn’t resist the bargin and purchased big bags of gummy candy.

The rest of the time, I binged at my daughters house.  She really is trying to help but just doesn’t understand the word obsession. She will save all of the Halloween Candy and put it in a candy bowl on her counter for guests. Her family has been programmed to avoid eating candy and drinking any type of carbonated  beverage. Before I started the diet she scolded me at Thanksgiving  when she noticed I had not only eaten the candy bowl, but found her stash and eaten my favorites out of that and was working on the rest. I had compulsively eaten more candy in two days than her whole family had in three weeks. 

This started the Great Obesity Debates and the fact that I couldn’t go to Space Camp with my Granddaughters unless I dropped 40 pounds.  She thought my obsession with candy and food was more disgusting and obscene than the bottle of wine I drank every night. I have gotten better, well a little bit anyway, with a lot of  help from her.  Since no one in her house really likes or eats candy, she quietly discards it after Halloween right before I come.  The same is true of Easter.

My only temptation is when I search for and find her stash of Girl Scout Cookies, which she likes and it only takes an hour or two for me to eat the whole box. When she discovers the missing cookies, I put partial blame on her kids and Cousin Cait but she knows I’m lying.  I feel so ashamed, I normally only do one box per trip unless she doesn’t catch me. 

You can shed fat, you can’t shed obsessions.