[jmckennnnanna (OP)]

I have had severe ADD for the last 19 years (obviously from inception) and have become very familiar with how it makes me feel physically, and ive recently had the revelation that most of my discomfort occurs as a surge of discomforting stimulation in my upper spine, as well as a subtle t-shaped pressure stimulation in the back of my head.

If i sit down and work on something for too long, it feels like a pressure builds up in this area and inclines me to jump up and sprint into the wall. Specifically i tend to have a strong urge to continually, frequently and vigorously arch my back as a means of straightening or curving my spine outward while tilting my head backward. I cant help but feel that there is some sort of chemical blockage in that part of the spine, constraining a chemical delivery system to the brain, resulting in the the ADD symptoms, which to my understanding are derived from hypofunction in the DA system. Now i'm a premed student and am hoping to be a neurologist specializing in ADD and am curious to know if any neurotransmitters or other chemicals pass through here that are critical to attention and cognitive performance. Its to my understanding that ADD is mainly caused by hypofunction in the DA system (rewards system), and that neurotransmitters transfer through the spine into the brain to carry out motor functions. But my understanding is limited, and im pretty sure that motor related neurotransmitters dont affect analytic ability. So What would explain this inclination to arch my back and how it relates to my Attention Deficit Disorder? do any chemicals travel through that part of the spine that are crucial to the Reward system of the brain or other areas?

Articles would be welcome, Thanks

*an added note; in addition to arching my back and tilting my head backward, I also arch my shoulders backward as well, which seems to squeeze and additionally arch my spine. I'm not hasty to dismiss the connection between my spine and my condition on the grounds that i do 3 independent things that all seem to affect the linearity of the spine and brainstem, which could suggest statistical significance.

I should also note that i'm doing a paper for my medterm101 class, so this isn't just random inquiry, i'm trying to find a focus for the paper

[RD]

... Specifically i tend to have a strong urge to continually, frequently and vigorously arch my back as a means of straightening or curving my spine outward while tilting my head backward.

People diagnosed with ADD are unduly likely to have motor-tics  ...

motor tics (bodily movements) – such as facial twitching or shrugging the shoulders ... Tics can start with a feeling of tension that builds up inside you (a premonitory urge). ... The sensation increases if you try to prevent the tic. After you've made the movement or sound, you may feel a sense of relief until the need to tic begins again.

http://www.nhs.uk/Conditions/tics/Pages/introduction.aspx

Some debate as to whether the tics are due to the neurological disorder, or the stimulant [amphetamine-like] medications.

[jmckennnnanna (OP)]

Well, i get the "tic" when im not on the medication, which i only take for school, so ill be off of it for several months during the summer and still get it, which im somewhat sure   eliminates the argument that this PARTICULAR tic is stimulant related. I know the difference between stimulant related tics and actual physical responses, as i get eye twitches too and those are stimulant related, but theyre habitual, ritualistic, and irrational. I can tell from experience that the urges of these tics are purely psychological and there is no physical urge to carry them out. You twitch your eye if you think or sense a particular condition with the superstitious fear that the universe will punish you if you dont, the eye doesnt hurt, or anything. So this controversy wouldn't go anywhere because the two sides are describing two different kind of ticks.

[RD]

Tics can be far more conspicuous and complex than a twitching eye : here's one which involves head tilting back ...

[alancalverd]

In reply to the opening question: yes. I've just returned from a day in the USA learning about "craniocervical syndrome" that has been researched by my colleagues at the Fonar Corporation  http://www.fonar.com/Symposium2013 and treatment developed by Scott Rosa rosaclinic.com/scott-rosa. 

is Rosa's symposium presentation and worth a look.

The underlying hypothesis is that a severe restriction of the flow of cerebrospinal fluid prevents the removal of neurotoxins produced in the corpus callosum, resulting in a range of symptoms from motor dysfunction to loss of memory and autism. The initiating event in adults often appears to be a whiplash incident but there is a suspicion that upper cervical misalignment can be caused by birth or early childhood trauma.

http://www.newsday.com/sports/football/li-doctors-help-jim-mcmahon-get-his-life-back-and-they-can-help-others-too-1.9493358 is a spectacular case.

Diagnosis requires an upright MRI scan. I don't have statistics on the success rate of treatment by chiropractic manipulation but it's worth enquiring. The phraseology of your question suggests you are US-based, but if you are in the UK please send me a personal message through this forum: I have the appropriate MRI facility and I can put you in touch with one of Rosa's colleagues who practises here.   

[RD]

In this case the person has an ADD diagnosis, (a cognitive dysfunction), and facial tics (which can't be due to spine), so their various urges to "jump up", "sprint" and  arch their back are consistent with yet more tics.  Hypothetically redistributing CSF* which included neurotoxins by flexing spine would not provide an instantaneous effect. Whereas after the tic, sufferers get instantaneous relief from the urge to tic, until the next tic. 

[ * cf. an epidural anaesthetic takes minutes to kick-in ]

... superstitious fear that the universe will punish you if you dont ...

If irrational fear is a reason for repetitive actions, you should have a look at OCD ... http://en.wikipedia.org/wiki/OCD#Compulsions

ADD + OCD combination is possible.


Do I need warn a pre-med student to stay away from orthodox chiropractors ? ... http://rationalwiki.org/wiki/Chiropractic

[alancalverd]

Do I need warn a pre-med student to stay away from orthodox chiropractors ? ... http://rationalwiki.org/wiki/Chiropractic

Matthew 7:16  By their deeds shall ye know them.

I have no idea what you or "rationalwiki" means by an orthodox chiropractor (most of those I know are Episcopalian)  or whether you understand the concept of luxation and subluxation (all of the neurosurgeons I work with do), but there's little doubt that Rosa's technique works, with both clinical and radiological evidence of its effect. The key is to get an accurate diagnosis, for which upright MRI is (a) harmless, (b) definitive and (c) essential.

[RD]

I have no idea what you or "rationalwiki" means by an orthodox chiropractor (most of those I know are Episcopalian)  or whether you understand the concept of luxation and subluxation ...

The orthodox, aka "straight" chiropractors misuse the word "subluxation" claiming their adjustments realign the spine. In reality [radiologically] no-such dislocation & relocation occurs. It's a scam , which occasionally causes the customer to have a stroke as a result of having their neck rapidly "adjusted" ...

[alancalverd]

You can't have it both ways! Either chiropractic manipulation does alter spinal geometry, in which case it might damage an artery (particularly one that has previously been coiled or stented, as in the case you quote), or it doesn't, in which case it can't.   

I haven't met a chiropractor (and I have worked with several hundred in the last 40 years, developing and improving their radiological technique) who misunderstood the meaning of subluxation. I remain sceptical of some claims but there's no doubt about the McMahon CSF case - I've seen the pre- and post-treatment images, and the fact that the patient's signs and symptoms have been relieved suggests either that chiropractic treatment works, or that Scott Rosa is a reincarnation of the Son of God. You choose.   

[RD]

You can't have it both ways! Either chiropractic manipulation does alter spinal geometry ...

Their X-rays before and after "adjustment" are the same. No dislocation , no relocation.  There is momentary separation of the vertebrae which produces the pop/crack , just like cracking knuckles.

... it might damage an artery (particularly one that has previously been coiled or stented, as in the case you quote ...

OK here's a study which shows people (under 45) who have visited a chiropractor are unduly likely to have a VBD ...

Results—Results for those aged <45 years showed VBA cases to be 5 times more likely than controls to have visited a chiropractor within 1 week of the VBA ... No significant associations were found for those aged ≥45* years.

http://stroke.ahajournals.org/content/32/5/1054.abstract

Bear in mind chiropractic "adjustment" has no proven benefit. Even a remote risk of stoke is no worth taking for no benefit.

[ * maybe a greater, (more damaging), force is required to "crack" vertebrae of younger people, compared with oldies, so the older customers don't get an increased incidence of VBD ].

[alancalverd]

So Jim Mc Mahon just got lucky after years of pain and suffering, the MRI-measured CSF flows before and after treatment were entirely bogus, the reduction in MRI-imaged brain lesions was an artefact, the visible realignment of his C1/C2 junction is the result of wishful thinking, and  the two professors of radiology and the professor of neurosurgery who supervised this case are blind morons. Thank you for your expert insight.

Perhaps you would care to comment on the other 3 cases that were presented. How sad that patients whose treatment had no proven benefit, are now leading normal lives. They must be delusional.

I don't recall anyone mentioning "cracking" anything at the conference. But I'm sure you know what you are talking about. After all, it's in a paper!

Incidentally the abstract goes on

While our analysis is consistent with a positive association in young adults, potential sources of bias are also discussed. The rarity of VBAs makes this association difficult to study despite high volumes of chiropractic treatment.

but who cares about statistical significance? Only boring scientists.

[RD]

I don't recall anyone mentioning "cracking" anything at the conference.

Chiropractors will keep applying force until they get a pop/crack noise: that's what the customers are paying for, mistakenly thinking that noise means something has been relocated , (the chiropractor has incorrectly told them they have "vertebral subluxation", if the customer looks up the word "subluxation" they will see means dislocation , which they do not actually have ).   

Perhaps you would care to comment on the other 3 cases that were presented.

"3 cases" is very low sample size. Whereas the VBD study I linked to showing chiropractic manipulation quintuples ones risk of VBD had 500+ subjects, and a control group. Also the VBD study is from a disinterested party.

... How sad that patients whose treatment had no proven benefit, are now leading normal lives. They must be delusional.

Patients [or physicians] are not necessary delusional or dishonest: spontaneous remission is a possible explanation for improvement where the treatment was actually useless. If your study had a large (100+) population and matched control-group, (and preferably an objective measure of outcome) , then you'd be in a position to tell if a treatment was actually effective. A handful of cases is not sufficient to make a reliable conclusion about a treatment's efficacy.

[alancalverd]

Chiropractors will keep applying force until they get a pop/crack noise: that's what the customers are paying for, mistakenly thinking that noise means something has been relocated

Not in these cases (nor in many others, including my own). Some manipulations, whether performed by chiropractors, osteopaths or physiotherapists, produce an audible noise, some don't. But your ignorance and prejudice seem to be no disqualification for comment.

An effective treatment is one that works for the patient you have. That's called good medical practice. Are you suggesting that we shouldn't attempt new treatments or treat rare conditions, because we don't have the evidence of 100 previous attempts?   

You might care to debate the ethics of a control group in the case of a surgical intervention, or indeed any intervention that poses a known significant risk for a healthy person (e.g. radiotherapy). Would you really advocate manipulating the necks of people with no symptoms? The simplest and most ethical control for a novel treatment of a chronic condition is to measure the patient's function before and after.   

[evan_au]

You might care to debate the ethics of a control group...

I've just finished reading "Less Medicine, More Health" by Dr Welch.

It has some cautionary tales about the problems of conventional medicine when it is advocated without having a control group. Good control groups are sometimes hard to arrange:

• He gives the tongue-in-cheek example of a crossover study of jumping out of a plane without a parachute. The "crossover" part means that those that are given a real parachute for the first jump are given a sham parachute for the second jump(!)
  
• There have been more serious attempts to provide a control group. One was on arthroscopic treatment of the knee where the control group had an incision in the knee (to look like an arthroscope had been used), and both groups were kept them in the operating theater for the same amount of time. Recovery was supervised by nurses who did not know whether the patient was in the treated or the control group. 
  
• But many other examples where placebo effect is taken to be a real benefit of the medication
  
• Or the percentage of people who would have gotten better even without medication are taken as a benefit of the treatment.
  
• His "hobby-horse" is cancer screening, where screening highlights a vast majority of people who do not have symptoms and who do not have a condition that would have progressed to disease. By adding these people into the statistics for the disease (and treating them), the death rates from this condition plummet, promoting even more aggressive screening. But he gives examples where the death rate from the disease do not change despite the aggressive screening.
  

Anyway, my take-away from reading this book is that a control group is desirable wherever possible.
...and cherry picking results from well-constructed studies turns them into poorly-constructed studies.

[RD]

... Some manipulations, whether performed by chiropractors, osteopaths or physiotherapists, produce an audible noise, some don't. But your ignorance and prejudice seem to be no disqualification for comment.

My criticism was specific to orthodox / "straight" chiropractors,  ( not physiotherapists ). Orthodox chiropractors are in the realm of pseudoscience ... https://www.sciencebasedmedicine.org/questions-and-answers-about-chiropractic-the-bottom-line/

Are you suggesting that we shouldn't attempt new treatments or treat rare conditions ...

Chiropractic isn't new : it's creator, D.D. Palmer, (a man jailed for practising medicine without a license), came up with the idea over a century ago.

You might care to debate the ethics of a control group in the case of a surgical intervention, or indeed any intervention that poses a known significant risk for a healthy person (e.g. radiotherapy). Would you really advocate manipulating the necks of people with no symptoms? 

To find out if a [new] treatment is effective, the control-group can just be a comparable group of untreated sufferers, (although applying a convincing sham-treatment to the control-group would be ideal). Then the only ethical problem arises if there already is a proven-treatment for the condition which the participants in the trial would have had access to.