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The Effect Of Weather On OA Knee Pain

7th March 2019

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Many of us are familiar with stories of people with injuries or joint conditions claiming to be able to predict the weather based upon their pain and stiffness. Whilst they are often met with polite nodding or even ridicule, there is evidence that there may be a genuine link between weather conditions and levels of pain. There is a growing body of research looking at the effect of weather on OA knee pain, but the results are far from conclusive.

How could the weather influence pain levels?

David Borenstein, a rheumatologist and clinical professor of medicine at George Washington University Medical Centre, reports that it is not unusual for joint pain to start before a storm when not even a single raindrop has fallen. Often people with joint pain will comment that the weather is going to be bad rather than complaining once a storm has already started.

One potential explanation is that levels of joint pain are linked to barometric pressure. Many people report that it is cold or damp weather which causes their joint pain, but there is some evidence to suggest that its actually barometric pressure which is most associated with joint issues. Barometric pressure is effectively the weight of the atmosphere which surrounds us all. When the barometric pressure is high, it pushes against the body and this prevents tissues from expanding.

However, before bad weather starts, the barometric pressure often reduces, meaning the force pushing against the body is reduced. Tissues can therefore expand and this expansion puts pressure on the joint causing stiffness and pain. For most people, the effect of changes in barometric pressure on the body are not noticeable. One exception with which many of us are familiar is the effect of travelling in a plane. Although plane cabins are pressurised, there are still variations as the plane ascends and descends and many people notice how their feet swell and then return to normal.

An alternative explanation is that the link is psychological rather than physical. One study compared patients who claimed their pain was weather sensitive to those who claimed they were not weather sensitive. The researchers found that women, less educated participants and more anxious and depressed patients were more likely to be weather sensitive. Individuals who were weather sensitive also had less of a sense of mastery over their lives.

Comparison of US cities

Robert Newlin Jamison is a chief psychologist at the Pain Management Center at Brigham and Women's Hospital in Boston. He carried out research, which was then published in the journal 'Pain', looking for links between chronic pain and weather in four US cities. These cities were San Diego, Nashville, Boston and Worcester.

Of the patients interviewed, two thirds claimed that there was a link between their levels of pain and weather conditions. In the majority of cases, the patients claimed that they could feel the changes in their joints before there were any changes in the weather. When the researchers compared reports from patients in different cities, they found that people living in San Diego were most sensitive to weather changes.

This surprised researchers as San Diego has the warmest climate compared with the two cities in Massachusetts or Nashville. The study found that San Diegan patients were sensitive to even very small weather changes. This evidence is far from conclusive and Jamison acknowledges that the research has mixed conclusions as there were a significant number of patients who reported that the weather does not affect their levels of pain.

Differences between countries

A Dutch study surveyed 712 participants who lived in Germany, Italy, the UK, the Netherlands, Spain and Sweden. The climates of these countries vary greatly so the intention was to determine how that affected the symptoms reported by the participants. The mean age of those who took part was 73 years and 67% of those reported that their levels of pain were sensitive to weather. Of the individuals who said they were weather sensitive, around 40% of them reported that their symptoms became worse in damp and rainy conditions while 30% said that only the cold caused them problems. There was also 5% who said that hot weather made their pain worse.

The researchers found that there were a higher proportion of patients claiming to be weather sensitive in countries with warm, dry climates such as Spain and Italy. A lower proportion of patients claimed to be weather sensitive in Sweden where the climate is cold and wet. The study also found that patients living in warm, dry climates reported higher levels of joint pain than those in colder and wetter climates. This was unexpected considering that more weather sensitive people said that cold and wet weather increased their pain.

The lead author of the study, Erik Timmermans suggested that the changes in joint pain were due to changes in humidity and temperature which affected the contraction and expansion of tissues within the arthritic joint. He hypothesised that low temperatures could make the synovial fluid more viscous and this would make the joint stiffer and could also make it more sensitive to pain from mechanical stress.

The exposure theory of OA joint pain suggests that the warm climates in both Italy and Spain may mean that patients in those countries spend more time outside than the patients who live in cold, wet Sweden. This may be why patients in those countries are more likely to report that their pain is weather sensitive. Essentially, patients are more aware of the weather when they spend more time outside so are more likely to notice a link between the weather and their pain.

The researchers pointed out that it is normal for OA patients to experience a low level of pain, or even an absence of symptoms, followed by 'flare ups' where pain levels are significantly raised. Patients may experience uncertainty regarding when their pain is going to come back and this can cause them to become anxious. It would, therefore, seem natural for them to want to find an explanation for their pain worsening and patients might thus want there to be a link between pain and weather.

The results of this study do not support the belief that OA knee pain is worsened by living in a cold and wet country, suggesting that moving to a warmer climate will not necessarily reduce a patient's pain. The researchers even went as far as suggesting that doctors could help their patients who report weather sensitive joint pain by using psychological and cognitive interventions as these may be able to reduce their suffering, helping them to live a more functional lifestyle.

How much of an effect does weather have?

A study carried out by Tufts University in 2007 examined the link between levels of joint pain and temperature and barometric pressure. Results showed that a temperature drop of 10 degrees was associated with an increase in arthritic pain. The study also found that reductions in barometric pressure increased pain, as did low temperatures and precipitation. The researchers suspected that this was the result of conditions in the atmosphere increasing swelling in the joint and thus causing pain.

What can you do about knee pain and the effect of weather?

Although it is certainly not clear whether there is a link between weather conditions and OA knee pain, if there is a link it may be possible to use this knowledge to manage joint pain. Keeping track of the weather forecast can inform you as to when pain levels may be increased. If you know there is a major storm coming then you may want to be particularly careful about taking medication correctly and, if possible, plan to avoid doing too much exercise around this time.

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