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Specific limb: A brief look at ‘restless legs syndrome’

Those that know me well often comment that I have a general inability to sit still and that I am a ‘fidget’. (This is not necessarily a bad thing and in fact there are some positives to fidgeting that I outlined in a previous blog on bad behaviours that are sometimes good for you). There is certainly some truth to the observation that I fidget but sometimes the fidgeting is out of my control. Every few weeks my right lower leg appears to take on a life of its own and I will get strange (uncomfortable) sensations (such as tingling, itching, and aching, and occasionally cramp-like feelings) that force me to move my right leg and foot around. It only happens when I am in a resting and relaxing state and usually lasts about 30 minutes (but can occasionally last much longer). On occasions it disrupts my work and sleep but I find that just getting up and moving around is sometimes enough to alleviate the uncomfortable feelings.


A few years ago I Googled my ‘symptoms’ and was surprised to find that I am not the only person who appears to experience such effects and that there is a whole medical literature on what has been termed ‘restless legs syndrome’ although in my case it would be in a singular rather than plural form). I’ve had the condition for about 15 years now and it may be related to some of the medication I take for an unrelated chronic degenerative health condition that I have. According to the Wikipedia entry on restless legs syndrome (RLS):

“The first known medical description of RLS was by Sir Thomas Willis in 1672. Willis emphasized the sleep disruption and limb movements experienced by people with RLS…The term ‘fidgets in the legs’ has also been used as early as the early nineteenth century. Subsequently, other descriptions of RLS were published, including those by Francois Boissier de Sauvages (1763), Magnus Huss (1849), Theodur Wittmaack (1861), George Miller Beard (1880), Georges Gilles de la Tourette (1898), Hermann Oppenheim (1923) and Frederick Gerard Allison (1943). However, it was not until almost three centuries after Willis, in 1945, that Karl-Axel Ekbom (1907–1977) provided a detailed and comprehensive report of this condition in his doctoral thesis, Restless legs: clinical study of hitherto overlooked disease. Ekbom coined the term “restless legs” and continued work on this disorder throughout his career. He described the essential diagnostic symptoms, differential diagnosis from other conditions, prevalence, relation to anemia, and common occurrence during pregnancy. Ekbom’s work was largely ignored until it was rediscovered by Arthur S. Walters and Wayne A. Hening in the 1980s. Subsequent landmark publications include 1995 and 2003 papers, which revised and updated the diagnostic criteria”.

As well as being referred to as RLS, it is sometimes referred to as Willis-Ekbom Disease or Willis-Ekbom Syndrome. Since being ‘rediscovered’ in the 1980s, there have been a lot of scientific papers published on the phenomenon although many of these are medical case studies (I don’t think my own experiences are extreme enough or strong enough to appear in any medical textbook. The Wikipedia entry on RLS provides a good summary of what is known medically and empirically:

“Restless legs syndrome (RLS) is a disorder that causes a strong urge to move one’s legs. There is often an unpleasant feeling in the legs that improves somewhat with moving them. Occasionally the arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep. Due to the disturbance in sleep, people with RLS may have daytime sleepiness, low energy, irritability, and a depressed mood. Additionally, many have limb twitching during sleep. Risk factors for RLS include low iron levels, kidney failure, Parkinson’s disease, diabetes, rheumatoid arthritis, and pregnancy. A number of medications may also trigger the disorder including antidepressants, antipsychotics, antihistamines, and calcium channel blockers. There are two main types. One is early onset RLS which starts before age 45 [years], runs in families and worsens over time. The other is late onset RLS which begins after age 45 [years], starts suddenly, and does not worsen. Diagnosis is generally based on a person’s symptoms after ruling out other potential causes… Females are more commonly affected than males and it becomes more common with age…Some doctors express the view that the incidence of restless leg syndrome is exaggerated by manufacturers of drugs used to treat it. Others believe it is an under-recognized and undertreated disorder…An association has been observed between attention deficit hyperactivity disorder (ADHD) and RLS or periodic limb movement disorder. Both conditions appear to have links to dysfunctions related to the neurotransmitter dopamine, and common medications for both conditions among other systems, affect dopamine levels in the brain”.

According to a review by Dr. Richard Allen and Dr. Christopher Earley in the Journal of Clinical Neurophysiology, RLS affects 2.5-15% of the US population. In another review on sleep disorder in the journal American Family Physician, Dr. Kannan Ramar and Dr. Eric Olson reported that RLS is typically characterized by four essential features: These are:

“(1) the intense urge to move the legs, usually accompanied or caused by uncomfortable sensations (e.g., “creepy crawly,” aching) in the legs; (2) symptoms that begin or worsen during periods of rest or inactivity; (3) symptoms that are partially or totally relieved by movements such as walking or stretching; and (4) symptoms that are worse or only occur in the evening or at night”.

Various online articles and papers report a variety of potential treatments based on the notion that RLS might be caused by a dopamine imbalance in the body. Some medics advise a regular sleep routine (such as that advised for those with insomnia), and cutting out the drinking of alcohol and the smoking of cigarettes. Pharmacological treatments include the use of drugs that are also used in the treatment of Parkinson’s disease such as L-DOPA and pramipexole, and the use of magnesium sulphate therapy (as reported in a 2006 paper in the Journal of Clinical Sleep Medicine – magnesium is known to be a natural muscle relaxant). In a 2011 issue of the journal Sleep Medicine, In an online article about RLS, Dr Michael Platt, author of the 2014 book Adrenalin Dominance, claims that RLS sufferers can be treated using a progesterone cream:

“Excess adrenalin during the night can cause restless leg syndrome. People often have associated symptoms also resulting from elevated adrenalin, such as teeth grinding, the need to urinate, and tossing and turning, and they often awaken in the morning with low back pain. Characteristically, RLS patients have an excess of adrenaline, may toss and turn all night, be quick to anger, might be workaholics, will usually have fibromyalgia (aches and pains – low back, side of the hips, and grind their teeth), they might drink too much, and will be hypoglycemic (sleepy between 3-4 p.m. or when in a car), and so on. There is an associated over-production of insulin and an under-production of progesterone…[By using a progesterone cream] I have had 100% success with eliminating RLS by getting hormones into balance, often within the first week. Patients feel more relaxed, they can sleep at night, rage disappears, and they can focus more easily”.

Dr. Luis Marin and his colleagues reported a different treatment for RLS altogether. They reported the case of a 41-year-old male RLS sufferer who after being on medication for RLS discovered his own solution – having sex. Following sex, the man reported that all RLS symptoms would disappear. Marin and colleagues speculated that the release of dopamine following orgasm might alleviate RLS symptoms. This appears to be a reasonable speculation given the findings of research published in the Journal of Neuroscience by Dr. Gert Holstege and his colleagues who examined brain activation at the point of ejaculation. In their paper they reported the similarity between ejaculation and using heroin in terms of brain activation:

“We used positron emission tomography to measure increases in regional cerebral blood flow during ejaculation compared with sexual stimulation in heterosexual male volunteers. Manual penile stimulation was performed by the volunteer’s female partner. Primary activation was found in the mesodiencephalic transition zone, including the ventral tegmental area, which is involved in a wide variety of rewarding behaviors. Parallels are drawn between ejaculation and heroin rush”.

It could well be that the increase in dopamine following ejaculation acts in a similar way to the medications that are given to RLS sufferers. Of all the treatments for RLS that I have read about, I think I know which one I would prefer!

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allen, R.P., & Earley, C.J. (2001). Restless legs syndrome: A review of clinical and pathophysiologic features. Journal of Clinical Neurophysiology, 18(2), 128-147.

Bartell S1, Zallek S. Intravenous magnesium sulfate may relieve restless legs syndrome in pregnancy. Journal of Clinical Sleep Medicine, 15, 187-188.

Chaudhuri, K.R., Appiah-Kubi, L.S., & Trenkwalder, C. (2001). Restless legs syndrome. Journal of Neurology, Neurosurgery & Psychiatry, 71(2), 143-146.

Ekbom, K., & Ulfberg, J. (2009). Restless legs syndrome. Journal of Internal Medicine, 266(5), 419-431.

Holstege, G., Georgiadis, J. R., Paans, A. M., Meiners, L. C., van der Graaf, F. H., & Reinders, A. S. (2003). Brain activation during human male ejaculation. Journal of Neuroscience, 23(27), 9185-9193

Leschziner, G., & Gringras, P. (2012). Restless legs syndrome. British Medical Journal, 344, e3056.

Marin, L.F., Felicio, A.C., & Prado, G.F. (2011). Sexual intercourse and masturbation: Potential relief factors for restless legs syndrome? Sleep Medicine, 12(4), 422.

Ondo, W. G. (2009). Restless legs syndrome. Neurologic Clinics, 27(3), 779-799.

Ramar, K; Olson, EJ (Aug 15, 2013). Management of common sleep disorders. American Family Physician, 88, 231–238.

Satija, P., & Ondo, W. G. (2008). Restless legs syndrome. CNS Drugs, 22(6), 497-518.

Test augmentation: 10 reasons why ‘Pokémon Go’ is so appealing

“Pokémon Go is a free-to-play location-based augmented reality mobile game developed…Making use of GPS and the camera of compatible devices, the game allows players to capture, battle, and train virtual creatures, called Pokémon [pocket monsters] who appear on device screens as though in the real world. The game is free-to-play, although it supports in-app purchases of additional gameplay items” (Wikipedia, 2016)

Unless you’re news-shy, off-grid, and/or a hermit, you can’t fail to have noticed all the media hype surrounding Pokémon Go. My youngest son and seemingly all of is friends have been out and about enjoying playing the latest gaming phenomenon. A lot of the press stories that I have read concentrate on the allegedly ‘addictive’ properties of the game (see ‘Further reading’ below). But what makes Pokémon Go such an appealing game? Here are my top ten reasons:

(1) It’s a popular franchise with a novel twist

Pokémon is a huge franchise with lots of associated spin-offs (animates films, carton television show, card games, figures to collect, etc.). And unlike some franchises, it’s a game that appears to be popular across age and gender but various aspects of the game (such as the use of augmented reality) give the game a novel twist on most other games (by utilizing real-world locations in which players explore their neighbourhood locality or wherever they happen to be).

(2) It’s fun, free to play, easy to play, and easy to access

Unlike many popular games, you don’t need a dedicated console to play the game. There is little in the way of barriers to entry. Anyone who has a smartphone can download Pokémon Go and it can be played anywhere at any time because it is played on a mobile device in which players try to catch Pokémon at specific locations (‘PokéStops’). This means that the number of potential users is huge, even in comparison to console games. In addition, there are no complicated buttons to press or controls to use. Most importantly it’s fun and free to play (but players can buy in-game items, an area that I’ve done a bit of research on which I outlined in a previous blog).

(3) It’s nostalgic and a ‘blast from the past’

Pokémon Go features many of the early ‘classic’ Pokémon characters (the ones that you could name in a pub quiz) hailing back to the 1990s. As well as attracting new and younger players, adults who loved Pokémon as a child or teenager can now re-live some of their childhood and adolescence. In short, some players can experience something new yet familiar. A research review carried out by Dr. Constantine Sedikides and Dr. Tim Wildschut demonstrated that “nostalgia has remarkable implications for one’s future. It strengthens approach orientation, raises optimism, evokes inspiration, boosts creativity, and kindles prosociality. Far from reflecting escapism from the present, nostalgia potentiates an attainable future”. A number of online articles coomenting on the popularity of Pokémon have included quotes about the game’s nostalgic element from Dr. Jamie Madigan (author of the 2015 book Getting Gamers: The Psychology of Video Games and Their Impact on People Who Play Them). He asserted that if nostalgia is in play, and it evokes this positive emotion…our brain can substitute the question, ‘Does this make me happy’ for ‘Is this a good game?’”

(4) It’s a social game (if you want it to be)

Back in the early and mid-2000s I published a number of studies showing that the most important reason for playing online multiplayer games was for social reasons and to connect and interact with other players. The great think about Pokémon Go is that meeting other players face-to-face is almost inevitable as the game is played outside and on the move, and it’s easy to spot other like-minded players. People can make new friendships or consolidate existing ones. Players talk to each other and can share their experiences. Some may even have shared memories that plugs into feelings of nostalgia. However, Pokémon Go players (if they so wish) can play on their own too. The game is flexible enough to adapt to the player.

(5) It features augmented reality

One of the defining features of Pokémon Go is that augmented reality is a fundamental (and arguably the main) part of the game. Augmented reality (AR) is defined as “a live direct or indirect view of a physical, real-world environment whose elements are augmented (or supplemented) by computer-generated sensory input such as sound, video, graphics or GPS [global positioning system] data”. Pokémon Go has successfully managed to embed AR into the game which some players claim makes characters feel “more alive”. An article on the phenomenon in Time magazine said that Pokémon Go provides “the illusion that wild Pokémon are out there in the real world, waiting to be caught”. There are also some claims (such as a paper by Dr. Keith Bujak and his colleagues in a paper published in a 2013 issue of the journal Computers and Education) that augmented reality can be potentially addictive. The authors claim that children are most at risk from AR addiction and assert that:

“Augmented reality does not separate the user from his reality but instead uses it and realistically transforms it…This effect can cause a high degree of surprise and curiosity in users”.

(6) It’s motivating

Any one who plays videogames or researches in the area knows that successful games have to be motivating to play. Rewards within Pokémon Go help players to foster achievement, and achieving goals within the game drives motivation. As an article on the Keep It Suitable website noted: “The self-confidence that arises from the achievement of a goal – catching a Pikachu – motivates people to play more and more…and ‘Pokémon Go’ players are indeed very motivated…The ease with which the reward comes every time your phone buzzes, alerting you that a Pokémon is nearby, is very basic psychological conditioning”.

(7) It involves collecting

In a number of my previous blogs I have written about the psychology of collecting and this also appears to be one of the attractions concerning all things Pokémon (in fact the Pokémon mantra has always been “Gotta catch ‘em all”). In my articles I have always referenced the work of Professor Russell Belk who has written a lot of books and papers on the topic. He was interviewed by Forbes magazine on the topic of Pokémon Go. The Forbes article noted:

“In a 1991 article published in the ‘Journal of Social Behavior and Personality’, Belk described two main types of collecting: aesthetic and taxonomic. Aesthetic collecting occurs when objects aren’t in limited supply and so adding things to your collection depends on personal preferences. This includes artwork, but not pocket monsters. ‘I expect no matter how beautiful or ugly the Pokémon is, there’s relatively little aesthetic judgment,” says Belk…’You want them all — or as many as possible’. Collecting Pokémon is a lot like building a coin or stamp collection. It involves taxonomy – the process of naming and classifying things into groups. Taxonomic collecting can end temporarily but continue later: the original Game Boy games (Pokémon Red and Pokémon Blue) featured 151 monster ‘species,’ but sequels have pushed that number over 700. If ‘Pokémon Go’ remains popular and profitable in the long term, the app’s developer will no doubt add new species. Belk adds that the desire to collect isn’t driven by a need to complete a collection. ‘You’re not striving for that closure as much as striving for bigger and better collections…That implies some social comparisons – that your collection is in some sense better than theirs.”

In the same article, reference was also made to a just published literature review (‘Extended self and the digital world’) by Professor Belk in the journal Current Opinion in Psychology. In the paper Belk claims collecting has now gone beyond physical items and can now include the collecting of digital artefacts. As Belk notes:

“Collecting digital objects can have advantages over physical possessions. While coins and stamps are kept in cabinets at home, you can store an entire collection of ‘Pokémon’ on your phone to show friends…One reason why ‘Pokémon Go’ is so popular is that it puts digital monsters in the real world. Like finding a rare book in an antique shop, this turns the discovery of Pokémon — the challenge or thrill of the chase — into a story. With augmented reality, they’ve made the ‘thrill of the hunt’ in a version where you can tweet about it, you can post about it on your website, you can carry around images of the Pokémon that you’ve collected…That’s a conversation piece, and something you can carry with you or brag about online.”

(8) It gets people active without them really knowing it

A number of articles on Pokémon Go have noted that playing the game has meant players having to go outdoors and walk miles to catch the Pokémon. In short, if you want to do well in the game, you have to get out the house and do some exercise. As one article summed up on this aspect: ‘The running meme is that Pokémon Go managed to do in 24 hours what Michelle Obama could not manage over the course of 8 years: get people outside and active…It turns out gamification of healthy activities can be done and that’s potentially a huge win for the gaming subset of our society that doesn’t exactly have the healthiest track record”. Personally, I’m not convinced that Pokémon Go is as good as more traditional ‘exergaming’ (such as playing Wii Sports) but I can’t deny that it gets people out of a sedentary routine.

(9) It’s a never-ending game

Pokémon Go is a non-linear game in which every user’s playing experience is different given that it uses the person’s individual geo-location. Like many massively multiplayer online games, there is no end to the game and some players continue playing because of FOMO (fear of missing out). Ultimately there is theoretically no limit to how many Pokémon a player can catch or how the game might evolve over time.

(10) The rewards are unpredictable

Over the years I have written countless papers talking about the role of random ratio reinforcement schedules (operant condition processes) that underlie repetitive behaviour (that in extreme cases can result in gambling and gaming addictions). In simple terms, playing a videogame or a slot machine results in intermittent and unpredictable rewards. Knowing when a reward is coming gets boring in the long run but games where the player doesn’t know when the next reward is coming (like when in the Pokémon Go game, the player will next see a Pokémon to catch). Anticipated rewards (similarly to actual rewards) also facilitate dopamine (one of the most important ‘feel good’ neurotransmitters in the human body) release in the body. In fact, a paper by Dr. Patrick Anselm and Dr. Mike Robinson published in the journal Frontiers in Behavioral Neuroscience argued that dopamine release “seems to reflect the unpredictability of reward delivery rather than reward per se” and suggests that the motivation to gamble or play videogames “is strongly (though not entirely) determined by the inability to predict reward occurrence”. In short, playing Pokémon Go can keep you playing longer than you might have originally intended.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Anselme, P. & Robinson, M.J.F. (2013) What motivates gambling behavior? Insight into dopamine’s role. Frontiers in Behavioral Neuroscience, 7, 182. doi: 10.3389/fnbeh. 2013.00182

Belk, R. W. (1991). The ineluctable mysteries of possessions. Journal of Social Behavior and Personality, 6(6), 17-55.

Belk, R. (2016). Extended self and the digital world. Current Opinion in Psychology, 10, 50-54.

Bujak, K.R., Radu, I., Catrambone, R., Macintyre, B., Zheng, R., & Golubski, G. (2013). A psychological perspective on augmented reality in the mathematics classroom. Computers & Education, 68, 536-544.

Chamary, J.V. (2016). Science explains why you’re addicted to Pokémon GO. Forbes, July, 12. Located at:

Cleghorn, J. & Griffiths, M.D. (2015). Why do gamers buy ‘virtual assets’? An insight in to the psychology behind purchase behaviour. Digital Education Review, 27, 98-117.

Cole, H. & Griffiths, M.D. (2007). Social interactions in Massively Multiplayer Online Role-Playing gamers. CyberPsychology and Behavior, 10, 575-583.

Griffiths, M.D., Davies, M.N.O. & Chappell, D. (2003). Breaking the stereotype: The case of online gaming. CyberPsychology and Behavior, 6, 81-91.

Griffiths, M.D., Davies, M.N.O. & Chappell, D. (2004). Demographic factors and playing variables in online computer gaming. CyberPsychology and Behavior, 7, 479-487.

Griffiths, M.D., Davies, M.N.O. & Chappell, D. (2004). Online computer gaming: A comparison of adolescent and adult gamers. Journal of Adolescence, 27, 87-96.

Duhi, A. (2016). Caught ’em all?: Why Pokémon Go is so addicting. FSU News, July 19. Located at:

Eadiccio, L. (2016). Psychology experts explain why ‘Pokemon Go’ is so addictive. Time, July 12. Located at:

Goodwin, R. (2016). Why the hell is everyone so addicted to Pokemon Go? Know Your Mobile, July 14. Located at:

Keep It Suitable (2016). 10 Reasons from real users: Why is Pokemon Go so addictive? July 16. Located at:

Kubas-Meyer, A. (2016). Pokémon GO Is the most addictive gaming app ever. Daily Beast, July 11. Located at:

Sedikides, C., & Wildschut, T. (2016). Past forward: Nostalgia as a motivational force. Trends In Cognitive Sciences, 20(5), 319-321.

Smith, C. (2016). Science explains why you’re so addicted to Pokemon Go., July 13. Located at:

Wikipedia (2016). Pokémon Go. Located at:émon_Go

Williams, C. (2016). Why everyone is addicted to Pokemon Go. Looper, July 14. Located at: