I remember being amazed by my uncle. He has arthritis in his knees and as a small child I was fascinated by his ‘psychic knees’. And by ‘psychic’ I am really describing the situation where he would look at me and knowingly state, “It’s going to rain…my knees are aching.” And then it would! How did his knees know? What aspects of weather could possibly be influencing his knees? Pressure? Humidity? Overall temperature? The dreary knowledge that if it rains he won’t get the crops in?
My uncle certainly isn’t alone. It’s estimated that anywhere from 50-100% of people with a painful condition report that their pain is influenced by the weather (1,2,3) – particularly changes in the weather. Some people report that their pain increases prior to a weather change, some report pain increases during a weather change, and some after. So if so many people report it, it must exist, right? Well, that is what Gier Smedslund and Kare Hagen aimed to find out. They recently published a systematic review that evaluated the relationship between weather (atmospheric and solar variables) and pain reports in people with rheumatoid arthritis.(4) They did loads of searching, lots of reading, and plenty of discussing and came up with 9 studies that met their eligibility criteria.
Their results were surprising to say the least. Despite heaps of anecdotal evidence supporting the relationship between pain and atmospheric variables, at the group level, there was no relationship at all between reported pain and the weather. This included pooling data from numerous studies for the variables of temperature, relative humidity, and for atmospheric pressure. There were 2 studies in the review(5,6) that analysed data at an individual level and they found that 16% and 11% of participants had increased pain with changes in temperature (some with increased temperatue, some with decreased) and 6% and 11% of participants were sensitive to changes in relative humidity (again, some sensitive to increased humidity and vice versa). These percentages are still miles away from the 60-100% of people who say their pain is affected by the weather!
So what could explain these results? Well, the authors provide some possible alternatives and I’ve added a few of my own.
First, there were some limitations to the included studies in the review – it was unclear in pretty much all the studies whether the atmospheric readouts (while great because they are standardised around the world) were measured at the same time as pain. Or should pain have been measured before and after? Further, it is also unclear how close (physically) or how relevant the recorded weather variables were to where the participants actually lived or to what they actually do in a day (ie, did they even go outside or did they stay in a temperature controlled house).
Second, is it possible that the variability in individual responses to the same weather variable (ie, some people have more pain with increased temperature and vice versa) cancelled each other out in the group level analyses, resulting in little to no correlation between weather and pain?
Or third, is our anecdotal evidence that pain is related to weather actually capturing something else? Perhaps we are falling under the trickery of cognitive mis-attribution (ie, we believe that pain is related to rain, so that we really take notice of all days where the pain has increased and it is raining but we tend to forget those days where we have an increase in pain but it is not raining)? Or perhaps it is mood-related. Is it the combination of weather change plus a bad mood or negative affect that is causing the increase in pain? Last, perhaps it is bio-physiological (not to be confused with bio-psychosocial). Is there something physiologically that is occurring during weather changes?
The authors identify a couple of studies that evaluate pain following controlled changes in temperature, humidity, and pressure using a controlled-climate chamber.(7,8) I would be fascinated to see more research in this area. Perhaps include some manipulations of patient expectation, some sham changes in atmospheric variables, and some manipulation of mood and affect, all while we directly control the ‘weather conditions’. It’s always nice to round out the physiological response data before we throw a theory away.
At the end of the day, based on this review, there is no evidence that changes in atmospheric variables influence pain in rheumatoid arthritis. However, I’m a little hesitant to tell that to my uncle’s ‘psychic knees’ before I know a little more.
About Tasha
Tasha Stanton is a postdoctoral research fellow working with the Body in Mind Research Group both in Adelaide (at University of South Australia) and in Sydney (at Neuroscience Research Australia). Tash has done a bit of hopping around in her career, from studying physio in her undergrad, to spinal biomechanics in her Master’s, to clinical epidemiology in her PhD, and now to clinical neuroscience in her postdoc. Amazingly, there has been a common thread through all this hopping and that common thread is pain. What is pain? Why do we have it? And why doesn’t it go away? Tasha got herself one of the very competitive Canadian IHR post-doctoral fellowships and is establishing her own line of very interesting investigations. Her research interests lie in understanding the neuroscience behind pain and its clinical implications. She also really likes nifty experiments that may have no clinical value yet, but whose coolness factor tops the charts. Last, Tash is a bit mad about running, enjoying a good red with friends and organizing theme parties. Tasha, aka Stanton Deliver, was the all round best performer at the Inaugural BiM Table Tennis Comp.
Here is Tasha talking more about what she does and a link to her published research.
We have put BiM author’s downloadable PDFs here.
References
1. Hendler NH, Jamison RN, Morrison CH, Piper JK, Kahn Z. The relationship of diagnoses and weather sensitivity in chronic pain patients. J Neuromusculoskelet Syst 1995; 3:10-5.
2. Jamison RN, Anderson KO, & Slater MA (1995). Weather changes and pain: perceived influence of local climate on pain complaint in chronic pain patients. Pain, 61 (2), 309-15 PMID: 7659442
3. Shutty MS Jr, Cundiff G, & DeGood DE (1992). Pain complaint and the weather: weather sensitivity and symptom complaints in chronic pain patients. Pain, 49 (2), 199-204 PMID: 1608646
4. Smedslund, G., & Hagen, K. (2011). Does rain really cause pain? A systematic review of the associations between weather factors and severity of pain in people with rheumatoid arthritis European Journal of Pain, 15 (1), 5-10 DOI: 10.1016/j.ejpain.2010.05.003
5. Dequeker J, & Wuestenraed L (1986). The effect of biometeorological factors on Ritchie articular index and pain in rheumatoid arthritis. Scandinavian journal of rheumatology, 15 (3), 280-4 PMID: 3798044
Smedslund, G., Mowinckel, P., Heiberg, T., Kvien, T., & Hagen, K. (2009). Does the weather really matter? A cohort study of influences of weather and solar conditions on daily variations of joint pain in patients with rheumatoid arthritis Arthritis & Rheumatism, 61 (9), 1243-1247 DOI: 10.1002/art.24729
7. Hollander JL. The controlled-climate chamber for the study of the effects of meteorological changes on human diseases. Trans NY Acad Sci 1961;24:167-72.
8. Hollander JL, Yeostros S. The effect of simultaneous variations of humidity and barometric pressure on arthritis. Bull Am Meteorol Soc 1963;44:489-94.
Many of chronic pain patients refer an increase of pain when it is cold or in winter time.
Another explanation (mood changes is a good one) could be an increase sensitivity on the CNS due to weather changes
What’s your opinion?
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From a statistical point of view, having positives cancel out negatives is easily solved. Remove the negative, and make them positive too! You are looking for change, not whether or not it is reducing pain, or increasing pain, but change, and that is always positive. You can do anything with statistics, except fly!
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Hi Rafael and Len,
Thanks for your comments! I’ll start first with yours Rafael. Well, the easiest answer to your question about CNS sensitivity and weather changes is I don’t know! But I really like your thoughts on this. I reckon this could also be something that we could play with experimentally. Perhaps climate controlled chamber (or follow a group of patients, who say something specific about the weather, for a year) and possibly measure something like pressure pain threshold during the different weather conditions. It would be fascinating!
Len, great point about statistics! You are exactly right that we can solve the problem of positive cancelling out the negatives…but only if we have the individual patient data. Because this was a systematic review, for most of the studies, Smedslund & Hagen only had group-level data. You’ll notice for the 2 studies in which they did have individual level data (ref number 5 and 6), they did separate out the ‘positives and the negatives’ and they did find that a small percentage of people did have changes in their pain ratings during different weather conditions. Thanks for bringing that up!
Cheers!
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Great post Tasha!!! We must be thinking along the same lines….I just posted a very similar post to my blog last week!!!!
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What should we make of animal studies that suggest that weather changes do indeed increase neuropathic pain? e.g.
Neurosci Lett. 2011 Oct 3;503(2):152-6.
Low barometric pressure aggravates neuropathic pain in guinea pigs
Sato J, et al
It seems that systematic reviews such as this often either statistically regress to the mean, or to the null hypothesis, and seldom give insight (IMHO). Maybe this is more of a statement on our statistical methods than on our rheumatologic joints?
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if temperature doesn’t matter then how do heat and cold packs work? i have peripheral neuralgia, when I have ‘fire’ I throw the covers off my back, and although I might be cold, my pain settles. I also have a hunch (still trying to make sense of it after 5 years!) that it’s the dramatic change in pressure that makes the difference.
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I have arthritis in my wrist after a triple colles fracture and although I’ve had CRPS it is now in remission. My observations lead me to suspect barometric pressure change might be the cause of intense bone pain. This ocurs when there is a sudden drop in pressure before a storm or significant weather event. Pain goes when things normalize so not prolonged pain. I’ve also experienced the same pain in a plane but only at certain heights. (I guess a pressure chamber could test this). This pain is not the same as that caused by cold.
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Hi Tash,
Great post! I like your thoughts about designing a study in a climate controlled chamber to measure pressure pain threshold during the different “weather conditions”. Perhaps thermal (especially cold) pain thresholds and tolerances would be useful to investigate too.
This topic reminds me of a wierd phenomenon from my cell biology days that was always a mystery. I used to record very tiny extracellular ion currents (0. 1 micro A/cm2) around bits of live tissue that were doing interesting developmental things (eg refs 1-3 below) and we often noticed that when the weather changed from fine to grotty, the recordings went haywire! It was pretty impossible to work out whether the ion currents or the equipment were being affected. However, the gear was all set up in a Faraday cage with voltage stabilisers etc etc. that minimise electrical interference.
So… this is probably be a totally out-there thought that this might in some way relate to Uncle Tash’s pyschic knees… but if what we observed were in fact changes in ion currents, then potentially (at a very long stretch) this has implications for sensory nerve function, as of course ion currents are what makes action potentials happen in neurons.
Crazy thoughts I know… but i couldn’t help putting it out there!
Julia
1. Hush JM, Newman IA and Overall RL. (1992) Utilization of the vibrating probe and ion-selective microelectrodes to investigate electrophysiological responses to wounding in pea roots. Journal of Experimental Botany 43: 1251-1257
2. Hush JM, Overall RL and Newman IA (1991) A calcium influx precedes organogenesis in Graptopetalum paraguayense. Plant, Cell & Environment 14: 657-665
3. Hush JM and Overall RL. (1989) Steady Ionic currents around pea (Pisum sativum L.) root tips: the effects of tissue wounding. Biological Bulletin 176 (S): 56-64
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Wow – thanks for all the good comments everyone!
I’ll think I’ll reply in 2 lots…
Theo, I reckon we don’t throw away the animal study stuff, but I would argue that an experimental model of neuropathic pain in a guinea pig in a controlled environment is very different to a clinical model of what is considered nociceptive pain (I’m opening a HUGE can of worms here by calling arthritis noceiceptive pain) in humans. I do think it tells us to follow this up further. I really don’t think this SR gives us the ‘answer’ to the question at this stage. If we don’t have a solid theory to why different weather changes would affect pain, then it becomes tough to determine if we’ve evaluated it properly. So I think you raise an excellent point of keeping our heads on straight and considering all the evidence. BTW, I had to look up IMHO…I like it!
Soula – very interesting point and I don’t think this study in any way can comment on ice or heat packs. Here we are talking about very global weather patterns not something that is directly on the skin. This I would argue could have very different physiological responses. Many people that I have treated have confirmed that ice or heat packs seems to help, but often only while they are on.
Jeisa – that is a fascinating observation. Have you also had periods where you have intense bone pain, but there hasn’t been a change in pressure?
Oops – almost forgot about you Joe – thanks for your comments!!
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jeisea Reply:
February 9th, 2012 at 7:35 am
Hi Tasha
The only time I get intense “bone” pain is before a significant weather event or under certain cercumstances (think when plane is very high) when flying. The wrist is the only site of this type of pain. After many years of CRPS I can now recognize that pain as different from other pains. The deep bone pain is not CRPS related I believe. For me the distinctive pain of CRPS is “creapy” and goes with the urge to rip flesh to expose nerves to the air. It also involves a sense that the painful part is much larger than it is.
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Ahhhh…lot number 2.
Julia – thanks so much for your post. I am intrigued beyond belief…not only by your interesting observation but by your alter ego! I love it!
In regards to your observation about ion currents, the authors did bring up a possible bio-physiological method of weather influencing pain. They talked about sferics – very-low-frequency (VLF) atmospherics (aka sferics) which are pulse-shaped alternating electric and magnetic fields which originate from atmospheric discharges (lightning). What is really interesting is that there has been some research done seeing if these sferics are linked to headaches…seems the jury is still out.
Walach H, Betz HD, Schweickhardt A. Sferics and headache: a prospective study.
Cephalalgia. 2001 Jul;21(6):685-90.
Vaitl D, Propson N, Stark R, Schienle A. Natural very-low-frequency sferics and headache. Int J Biometeorol. 2001 Sep;45(3):115-23.
Incredibly interesting stuff!
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Thanks Tash! Curiouser and curiouser.
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Hello Dr. Stanton – Thank you for your post. It is very informative. I am one of those who am totally bewildered by the perceived correlation between weather changes and pain. Admittedly my doctor (who is also a personal friend) told me some 30 years ago that I would “always have a barometer in my neck” subsequent to the herniation of discs at C4-C5 and C5-C6. So, more than a little power of suggestion may be involved. However, that said, the pain I feel when a cold front is coming in is nonetheless real in terms of my perceptions, and it is not in my neck. I’ve been diagnosed with Fibromyalgia (which of course is a catchall diagnosis that no one in their right mind would hang a hat on), so my pains are much more generalized than would be explained by herniated discs in the neck.
My case in point is last night. I had no idea a storm was coming into the Santa Fe, New Mexico area when I went to bed. I had an absolutely miserable night with pain in my low back, hips and elbows. I woke up and told my wife that I slept terribly and felt like I’d been beat with a stick. It was an hour later when the sky lightened that I realized it was drizzling / snowing lightly.
This is totally anecdotal, and being a bit of an amateur meteorologist I frankly don’t see any rational explanation. (The barometric pressure changes are so minuet and being inside the house all night the temp. changes are not a factor.) Nevertheless, the pain is significant and last night as is often the case, I could not have predisposed myself in advance to have a painful night inasmuch as I was totally unaware of the impending cold front.
It is a mystery that I share with your Uncle.
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Leggogarn – thank you for sharing your story. It is really stories like yours and like Jeisa’s and Soula’s that make it so compelling to research and understand things more. I find it really interesting that you were ‘blinded’ to the weather so to speak, and then had a terrible night of sleeping due to pain.
Based on this review alone, I’m definitely not ready to say that there is no link as some of the studies indicated that a small proportion of people were in fact sensitive to weather fluctuations. I guess it just becomes hard because certainly weather itself is not the only thing that affects pain. And this is where it becomes tricky to study.
Thanks very much for your post and I’ll pass the word onto my Uncle that he is definitely not the only one!
Cheers!
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tasha you can contact me anytime, would be a pleasure to help for research’s sake. or feel free to read through a blog i just created in attempt to raise awareness for pudendal neuralgia (pudendalnerve.com.au), my full story is on there.
cheerio, thanks for your efforts!
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I’ve had bad knees since birth. Up until age 18, I could predict weather changes, so I tracked my predictive abilities when I was 13 and was about 95% accurate. The ability came back about 5 years ago when I developed arthritis in those same evil knees. My mother also predictive abilities since she broke her hip about 3 years ago. I haven’t tracked the reliability, but I probably will now. It’s a bizarre affliction to have your pain increase greatly the day before bad weather, but I notice it especially since my laundry room is downstairs. Some days I can practically run down the stairs; other days, I’m in pain for no discernible reason. I don’t take pain medication, and can’t think of any other variables. I, too, think it’s a function of barometric pressure. I am also perhaps the most skeptical human on the planet, but there is a definite correlation.
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Soula – thanks for sharing your blog – I’ll definitely take a read. Also thank you for the kind offer of participation! It is really appreciated.
And Jude very interesting observations!
Cheers,
Tash
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Hi All,
With regards psychic knees then I go with theory three and it is an observer bias but backed by a strong cultural meme.
Generalising to seasonal pain fluctuation I find that idiopathic pain people seem to be subject to seasonal flare of pain – winter is worst. I have pondered whether at our latitude it fits with the vit D3 deficiency theory but can see no good evidence to support that yet. In particular the pain holiday that idopathic pain peole feel when they go on holiday to a hot place does not last very long on their return and the elevated levels of D3 would last much longer than their quick return to baseline pain symptoms suggests. That makes me favour percieived stress and pressure which ramps back up quickly on the return home -I need a holiday to catch up after my holiday. So overall I feel winter blues and the emotive circuitries amplification of pain experience still sounds best to me as a hypothesis.
Kind thoughts,
Steve
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Has anybody done studies in the Magnetic fields relating to pain. I feel the pain 1 or 2 days before the weather comes in. By the time it comes I feel better. I have Ehlers Danlos (connective tissue Disease) and alot of neuropathy. I feel my whole bodies nervous system hyperactive when it happens. Do you think the missing link here is the Magnetic fields changing with the storms?
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i would love to hear about magnetic fields too, thanks jerrymaki. Force, pressure, magnetic, electricity, all the things that come to mind with my eerie pain.
cheers
soula
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Could the relationship possibly not be associated with actual temperature and barometric pressure (which RCTs have demonstrated to not be correlated), but instead the brains perception that there is a threat to our body by the external environment? This would make sense with an understanding of the neuromatrix…and the possible predictive effects be related to seeing a weather report or hearing from someone else that “it might rain tomorrow”…and in addition, could the brain have within its neural networks, tags which remember historical climate conditions, and based on trends, send an output? Do you see where I am going with this???
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steve Reply:
February 23rd, 2012 at 7:53 pm
I figure the threat level of rain to be relatively low – your climate may be worse but mine is benign! I think that humans due to the salience of threat are wired to notice bad news. So we hook up associations within the neuromatrix. So notice bad weather, notice pain and associate. The pain tags into the ‘bad’ weather and our old friend B follows A so A causes B. So it goes. Very strong meme though. It does effectively demonstrate how flawed our self-justifications are and I use it sometimes to explain this concept to people who have equally inaccurate and unhelpful pain beliefs that are too concrete or personally important to erode directly.
ps Thanks for the CRPS advice:)
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Fantastic discussion all! I am quite interested in this idea of a cultural meme and how this impacts how we view and make sense of our world. Certainly in other areas there is some evidence that suggests that cultural memes can impact our perception of a noxious stimulus – ie, making something red makes it hurt more than if it was blue. This to me is incredibly fascinating that something that we have learned throughout our life – eg, red = danger, fire etc… – could impact our interpretation of incoming information.
Joseph – I also like your idea about the threat value of the external environment. I would also add to this – is it feasible that our pain memory (ie, if we are quite sure that our pain increases when a storm is coming) also contributes to the perceived increased threat value of the external environment? Talk about vicious circle!
Nice work folks!
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This is a bit off topic, but I just returned from Palm Springs where it was 93 degrees. I played five rounds of golf in three days, each round with use of a golf cart. Typically, I play one round in San Francisco right on the coast. I always walk, and most of the time I carry my bag. I can play one round and often don’t feel like I can do much else after a round due to stiffness and hip/back pain. It is very difficult to straighten up when I get out of the car when I get home (30-45 minutes). So, it seems that dampness or temperature has quite an impact on my level of pain. If it doesn’t, I would love to know what causes me to occasionally feel like I got hit by a truck after a round of golf.
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