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10 Articles in Volume 16, Issue #4
Achilles Tendon Injuries
Brain Trauma in Sports
Genetic Testing: Adjunct in the Medical Management of Chronic Pain
Letters to the Editor: Sleep Apnea, SPG Blocks for Migraines, Pancreatic Pain, CDC Guidelines
Pain and Weather—A Cloudy Issue
Phulchand Prithvi Raj, MD, Pioneer in Pain Management, Dies at 84
Physical Medicine & Rehabilitation
Preventing Chronic Overuse Sports Injuries
Sports-Related Pain: Topical Treatments
The “Missing Link” in the Physiology of Pain: Glial Cells

Pain and Weather—A Cloudy Issue

Numerous peer-reviewed studies have attempted to validate a correlation between patient pain and meteorological conditions, but documenting any sort of repeatable linkage remains a scientific enigma.
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In studying the biological effects of decreasing temperature and pressure on neuropathic or chronically inflamed rat models, Jun Sato formulated 4 mechanisms that may aggravate pain. First, low pressure directly triggers the sympathetic nervous system to stimulate chronic pain via local ischemia and vasoconstriction.21 Second, low temperatures increase heart rate, noradrenaline, and blood pressure, although the exact mechanism remains unclear.21 Third, cold temperatures trigger the release of adrenocorticotropic hormone and epinephrine, which aggravate pain via vasoconstriction, ischemia, and local decrease in temperature.21 Fourth, low temperatures can stimulate mast cells to release analgesic substances that heighten nociceptor activity.22

Alternatively, changes in barometric pressure may augment cytokine pathways. Strusberg et al demonstrated that applying hydrostatic pressure to chondrocytes increases expression of tumor necrosis factor-α and interleukin 6.1 Increased cytokine activity may damage host cells and help explain changes in perception of pain.

Canadian researchers Ngan and Toth have hypothesized that cold temperatures directly stimulate damage-sensing mechanisms via activation of voltage-gated channels.23 Others have studied transient receptor potential cation channel subfamily M member 8 (TRPM8) channels in temperature sensitivity24,25 and cold-induced ionic conduction.26 However, Ngan and Toth noted that there are likely a multitude of other factors that contribute to weather sensitivity, such as increased likelihood to remain inside on cold days.23

Alterations in barometric pressure can induce a state of transient disequilibrium that sensitizes nerve endings as well. Sensitized nerve endings may subsequently aggravate pain caused by changes in temperature or humidity. Experiments have shown that arthritic patients in climate-controlled rooms report greater pain when barometric pressure decreases and humidity increases, but not when only one of these two variables is changed.27

Other Weather-Related Associations

Different case-crossover studies evaluating the relationship between rheumatoid-type pain and weather changes have either concluded that only temperature affects middle-age patients (with no significant factors in any other age groups)28 or that high wind speeds increase risk of hip fracture without any other significant correlation to weather changes.29 A study of 2,121 patients admitted for hip fractures found increased frequencies of hip fractures on days with higher wind speeds; in fact, the windiest days had a 32% higher risk for hip fracture compared to calm days. Precipitation had no statistical correlation with hip fractures.29

A meta-analysis by Smedslund and Hagen in 2011 analyzed 9 different studies that investigated the pain-weather relationship; it concluded no correlation between rheumatoid pain and temperature, humidity, or pressure.30 However, they also concluded that statistical analyses of individual participants from 2 of the 9 studies uncovered that these 3 meteorological factors do influence pain in about 25% of rheumatoid patients. The data suggests that a minority of those suffering from rheumatoid arthritis may be more sensitive to meteorological changes, at least in regard to how these shifts stimulate rheumatoid pain. 30

Barometric Pressure

The way changes in atmospheric pressure aggravate joint pain deserves special attention, not only because it is more consistently tied to onset of pain than other meteorological parameters, but also because of its unobservable quality to the patient. As Brennan et al keenly note, despite the prevailing myth that rheumatoid patients can predict rainfall by the “aches in their bones,” most studies exploring the relationship conclude no correlation exists between arthritic pain and precipitation.2,9-13,15,16,28,31

Conversely, a handful of studies have connected changes in barometric pressure­—a parameter not consciously discerned—to onset of pain2,6-8,10-13,18 even though the extent of correlation has been contested. Controlled studies on neuropathic and rheumatoid-like rat models similarly indicate that drops in barometric pressure or temperature aggravate mechanical allodynia and hyperalgesia.21 This points to a physiological mechanism rather than a psychological process linking arthritic pain to barometric pressure.

Nonetheless, studies have produced mixed results regarding whether or not barometric pressure affects joint pain. Some researchers have found that increasing barometric pressure aggravates arthritis pain; in a 2007 study, researchers found a positive correlation tying temperature and pressure change to pain severity in osteoarthritic patients (Ppressure = .02, Ptemperature = .004).7 Other studies have reported that women are more sensitive than men to changing meteorological parameters (62% vs. 37%);6 yet others concluded that no such association exists between arthritis pain and barometric pressure.9

Other Types of Pain

Comparatively less research has been devoted to studying the link between weather and other sources of chronic pain, including fibromyalgia, sickle cell disease, migraines, lower back pain, and temporomandibular joint disorders. What little data is available may not accurately reflect the complex interactions that aggravate pain in these cases.

Sickle Cell Pain

Molokie, Wang, and Wilkie have proposed that nervous system overstimulation and damage from sickle cell disease result in neuropathic pain that manifests as both allodynic and hyperalgesic.32 However, the notion that sickle cell patients experience neuropathic pain has not been widely accepted by the medical community.32

As with arthritis, sickle cell disease (SCD) studies have reached contradictory conclusions. Experiments conducted in Georgia and London both report no association between temperature and frequency of hospital admissions.33,34 These results contrast studies done in Virginia, Canada, and France, which indicate a statistical significance between lowering temperature and pain35,36 or that high or low temperatures increase emergency room visits for SCD patients.37 Yet other studies have correlated sickle cell pain with certain meteorological factors, such as wind speed, but not others.5,6

A comprehensive meta-study that assessed the results and merit of several dozen SCD studies contended that overall, the connection between cold temperatures and wind speed with hospital admissions had significant outcomes for SCD patients.38 However, the researchers noted that no clear link has causally tied these environmental factors to pain, since few robust studies have demonstrated the mechanisms that aggravate sickle cell pain.38 The exact effects of cold and windy weather on SCD are thus difficult to discern, given the multivariable interaction of numerous other factors, including socioeconomic status, climate, physical activity, and likelihood of infection.38

Last updated on: May 17, 2016
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Letters to the Editor: Sleep Apnea, SPG Blocks for Migraines, Pancreatic Pain, CDC Guidelines

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