Posts Tagged ‘gallop organization’

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.

Advertisements