ChiroACCESS Article

Weather Changes, Atmospheric Pressure and Joint Pain

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ChiroACCESS Editorial Staff



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July 14, 2010

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It is common to have patients comment that they feel increased pain and stiffness accompanying changes in the weather.  Some claim to be virtual weather stations with accuracy surpassing the local meteorologist.  But is there any science to support these comments?  The answer is “yes”.

Weather and joint painAlthough there is not an overwhelming body of evidence as regrettably Mother Nature does not fund clinical trials, there are some pretty solid human studies.  There have been studies related to low back pain, osteoarthritis (OA) in multiple joints and rheumatoid arthritis.  The consensus of these studies is that barometric pressure is directly associated with increases in osteoarthritis joint pain.  Overall there is an inverse relationship; as barometric pressure decreases, pain increases.  Some subsets of the population have a greater change in pain than others and this appears to be true of both patients with osteoarthritis and other forms of arthritis.  One exception to decreased pressure increasing pain was reported in a 2003 study published in Rheumatology (Oxford).  The study discovered that  “…among women with hand OA, higher pain was significantly associated with days of rising barometric pressure (P<0.001).”   For low back pain patients with vacuum phenomenon, a 2002 study concluded that “low back pain might be aggravated by atmosphere depression in patients with lumbar disease associated with vacuum phenomenon.”  Another 1998 study reported “Weather conditions may influence subjective reporting of low back pain significantly.  Although the effects are small in magnitude, they should be considered in clinical treatment of the patient with chronic, nonspecific low back pain.  Pain scores may demonstrate greater interaction with certain weather conditions in individuals perceiving sensitivity to those conditions.”

There is some basic science research using a rat model that supports the relationship between decreased barometric pressure and increases in neuropathic pain (chronic constriction injury) as might be seen in humans with sciatica, piriformis syndrome or other similar clinical conditions.

Note:  These mini-reviews are designed as updates and direct the reader to the full text of current research. The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research.  Where permitted we will direct the reader to that full text. 

Changes in barometric pressure and ambient temperature influence osteoarthritis pain.  [LINK]

Am J Med. 2007 May;120(5):429-34.

McAlindon T, Formica M, Schmid CH, Fletcher J.
Division of Rheumatology, Tufts-New England Medical Center, Boston, Mass 02111, USA.

PURPOSE: Individuals with osteoarthritis often assert that change in the weather influences their pain, but the evidence is inconclusive. Our objective was to determine if short-term weather parameters influence knee osteoarthritis pain.

METHODS: We performed a longitudinal analysis of pain reports from a 3-month clinical trial among individuals with knee osteoarthritis dispersed across the United States. Daily values for temperature, barometric pressure, dew point, precipitation, and relative humidity were obtained from the weather station closest to each participant. We used a longitudinal mixed-model random effects analysis with a first-order autoregressive error structure to test for associations while accounting for within-patient correlation.

RESULTS: The study included 200 participants with knee osteoarthritis. Their mean age was 60 years (standard deviation [SD] 9.4), 64% were female, and 10.5% were African American or Hispanic. They had a mean body mass index of 32.5 kg/m2 (SD 8.4) and a baseline WOMAC pain score of 9.0 (SD 3.4). There were consistent associations of pressure change and ambient temperature with pain severity (change in barometric pressure, coefficient = 1.14, P = .02, ambient temperature = -0.01, P = .004; adjusted mutually and for age, gender, body mass index, nonsteroidal anti-inflammatory drug use, opiate use, and prior pain score). Interaction terms between change in barometric pressure and ambient temperature had no influence in the models.

CONCLUSIONS: Changes in barometric pressure and ambient temperature are independently associated with osteoarthritis knee pain severity.

Pain intensity and barometric pressure closely correlate in Southern Taiwan.

Acta Anaesthesiol Taiwan. 2006 Sep;44(3):147-52.

Liu YC, Tseng FL, Feng JY, Lam CF, Tsai YC.
Department of Anesthesiology, National Cheng Kung University Medical College, Tainan, Taiwan, ROC.

BACKGROUND: Previous reports suggest that weather changes may affect the attack and pattern of pain. However, a direct relationship between weather and pain attack is yet to be determined, especially when very limited data are currently available in the tropical or subtropical regions.

METHODS: We studied the patients who visited our clinic for pain management in Tainan, a city in southern Taiwan, in the space from February 2004 to December 2005. Intensity of pain measured by visual analogue scale (VAS) and the weather conditions including temperature, barometric pressure, humidity and wind speed at the time of measurement, were recorded.

RESULTS: Our results indicate that higher scores of the VAS were associated with older age and lower barometric pressure, while the associations with temperature, humidity and wind speed were not statistically significant.

CONCLUSIONS: Our results demonstrate a unique pattern of pain, which varies with barometric pressure, in the subtropical region and may provide reference for better pain intervention during change of weather.

Weather conditions can influence rheumatic diseases.

Proc West Pharmacol Soc. 2004;47:134-6.

Vergés J, Montell E, Tomàs E, Cumelles G, Castañeda G, Marti N, Möller I.
Scientific Medical Department, Bioibérica Farma, Plaza Francesc Macia 7, 08029 Barcelona, Spain.

In daily clinical practice, many patients attribute joint pain to weather conditions. There is little information published on this subject and most of it is contradictory. The objective of this study was to evaluate the effect of climatic conditions in rheumatic patients. The present work was carried out with patients attending the Instituto Poal de Reumatologia of Barcelona and the data were analyzed by Bioibérica Farma (Spain). It was a prospective, double-blind study including 92 patients with rheumatic disorders (80 with osteoarthritis, 12 with rheumatoid arthritis) compared to a control group of 42 subjects. The evaluation of pain (Huskisson VAS) and functional capacity (Health Assessment Questionnaire, HAQ) were determined daily during one month. The climatic variables studied were temperature, humidity and barometric pressure. The results obtained have been subject to binary regression analysis. Our data demonstrate that osteoarthritic patients experience increased joint pain in response to a decrease in pressure, indicating that low atmospheric pressure conditions exacerbate joint pain in these patients. Our work also suggests that some meteorological variables affect the occurrence of pain in rheumatoid arthritis, since we have found that low temperature increases the risk of joint pain. Therefore, these data suggest that in the future it may be possible to modulate pharmacological and non-pharmacological treatments for some osteoarthritic patients depending on the predictable weather conditions in order to avoid, as much as possible, the disease-associated joint pain and functional incapacity, thus improving patients' quality of life.

Osteoarthritis pain and weather.  [LINK]

Rheumatology (Oxford). 2003 Aug;42(8):955-8. Epub 2003 Mar 14.

Wilder FV, Hall BJ, Barrett JP.
The Arthritis Research Institute of America, Inc., Clearwater, Florida, USA.

OBJECTIVE: To evaluate the association between weather (barometric pressure, precipitation and temperature) and pain among individuals with osteoarthritis (OA) (n=154) at the following sites: neck, hand, shoulder, knee and foot.

METHODS: This prospective study evaluated men and women, aged 49-90 yr, participating in a community-based, osteoarthritis exercise study (June 1998-January 2002). Weekly self-reported pain scores were collected using a visual analogue scale. Statistical tests, including regression and correlation analyses, were conducted. P values < 0.001 were considered significant.

RESULTS: The total number of pain recordings varied by site, ranging from 2269 (feet) to 6061 (hands). The mean temperature was 23 degrees C with a low of 0 degrees C and a high of 36 degrees C. Precipitation levels ranged from 0.00-21.08 cm, with a mean of 0.36 cm. Most associations explored produced non-significant findings. However, among women with hand OA, higher pain was significantly associated with days of rising barometric pressure (P < 0.001).

CONCLUSION: Among a population of exercisers aged 49 yr and older, overall these findings did not support the hypothesis that weather is associated with pain. While some associations were suggestive of a relationship, largely these findings indicate that weather is quite modestly, if at all, associated with pain from OA.

Change of barometric pressure influences low back pain in patients with vacuum phenomenon within lumbar intervertebral disc.  [LINK]

J Spinal Disord Tech. 2002 Aug;15(4):290-3.

Kasai Y, Takegami K, Uchida A.
Department of Orthopaedic Surgery, Mie University Faculty of Medicine, Edobashi Tsu, Mie, Japan.

The present study investigates whether changes in barometric pressure influence low back pain in patients with vacuum phenomenon within lumbar intervertebral discs. Twenty-four patients with low back pain were examined: 12 with vacuum phenomenon within the intervertebral discs (VP [+] group) and 12 without the vacuum phenomenon (VP [-] group). All patients consented to an evaluation of low back pain in a hyperbaric oxygen chamber. In the VP (+) group, low back pain became more severe in one patient when atmospheric pressure was elevated, and in eight patients when atmospheric pressure was decreased. In the VP (-) group, two patients experienced more severe low back pain when atmospheric pressure was decreased. Our study demonstrated that low back pain might be aggravated by atmosphere depression in patients with lumbar disease associated with the vacuum phenomenon.

Meteorological conditions and self-report of low back pain.  [LINK]

Spine (Phila Pa 1976). 1998 Oct 1;23(19):2096-102; discussion 2103.

McGorry RW, Hsiang SM, Snook SH, Clancy EA, Young SL.
Liberty Mutual Research Center for Safety and Health, Hopkinton, Massachusetts, USA.

STUDY DESIGN: Six months of daily low back pain ratings for 94 individuals were tested for the influence of prevailing weather conditions during the spring, summer, and fall seasons. Intergroup differences were tested for study participants who reported weather sensitivity and for those who did not.

OBJECTIVES: To investigate the relation between pain ratings and prevailing weather conditions in a population with chronic or recurrent low back pain.

SUMMARY OF BACKGROUND DATA: Weather conditions have been reported to influence pain perception in some disease states, including low back pain. Investigations of this relation in chronic or recurrent low back pain have involved varied methodologies, and conflicting results have been reported.

METHODS: The effects of eight weather variables reported to influence musculoskeletal pain were tested on daily pain ratings. A post hoc weather sensitivity questionnaire was used to disperse 73 individuals into groups based on perceived weather sensitivity, and group differences were tested.

RESULTS: Significant effects on pain scores were found, most notably for temperature and vapor pressure. The magnitude of the effects were small compared with autocorrelation of an individual's own pain scores. Significant differences were found between the group of individuals who were insensitive to weather conditions and that of individuals with perceived sensitivity to cold temperatures. No significant intergroup differences were found for damp, rainy conditions or changes in barometric pressure.

CONCLUSIONS: Weather conditions may influence subjective reporting of low back pain significantly. Although the effects are small in magnitude, they should be considered in clinical treatment of the patient with chronic, nonspecific low back pain. Pain scores may demonstrate greater interaction with certain weather conditions in individuals perceiving sensitivity to those conditions.

The association between arthritis and the weather.  [LINK]

Int J Biometeorol. 1997 Jun;40(4):192-9.

Aikman H.
Department of Nursing, La Trobe University, Bendigo, Victoria, Australia.

Despite the prevasiveness of the idea that arthritis is influenced by the weather, scientific evidence on the matter is sparse and non-conclusive. This study, conducted in the Australian inland city of Bendigo, sought to establish a possible relationship between the pain and rigidity of arthritis and the weather variables of temperature, relative humidity, barometric pressure, wind speed and precipitation. Pain and rigidity levels were scored by 25 participants with osteoarthritis and/or rheumatoid arthritis four times per day for 1 month from each season. Mean pain and rigidity scores for each time of each day were found to be correlated with the meteorological data. Correlations between mean symptoms and temperature and relative humidity were significant (P < 0.001). Time of day was included in the analysis. Stepwise multiple regression analysis indicated that meteorological variables and time of day accounted for 38% of the variance in mean pain and 20% of the variance in mean rigidity when data of all months were considered. A post-study telephone questionnaire indicated 92% of participants perceived their symptoms to be influenced by the weather, while 48% claimed to be able to predict the weather according to their symptoms. Hence, the results suggest (1) decreased temperature is associated with both increased pain and increased rigidity and (2) increased relative humidity is associated with increased pain and rigidity in arthritis sufferers.

Effect of weather conditions on rheumatic patients.  [LINK]

Ann Rheum Dis. 1990 Mar;49(3):158-9.

Guedj D, Weinberger A.
Rheumatology Unit, Beilinson Medical Center, Petah Tikva, Israel.

In a one month prospective study of 62 rheumatic patients--16 with rheumatoid arthritis (RA), 24 with osteoarthritis (OA), 11 with inflammatory arthritis, 11 with fibromyalgia joint pain--swelling and everyday activity was compared with changes in daily weather conditions. In most patients weather changes increased arthritic symptoms. Women were more sensitive to weather than men (62% v 37%). Pain was affected positively by barometric pressure and temperature in RA, by temperature, rain, and barometric pressure in OA, and by barometric pressure in fibromyalgia. These results support the belief of most rheumatic patients that weather conditions significantly influence their day to day symptoms.

The rate and magnitude of atmospheric pressure change that aggravate pain-related behavior of nerve injured rats.  [LINK]

Int J Biometeorol. 2010 Jun 24. [Epub ahead of print]

Funakubo M, Sato J, Obata K, Mizumura K.
Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8601, Japan.

Complaints of patients with chronic pain may increase when the weather changes. The exact mechanism for weather change-induced pain has not been clarified. We have previously demonstrated that artificially lowering barometric pressure (LP) intensifies pain-related behaviors in rats with neuropathic pain [chronic constriction injury (CCI) and spinal nerve ligation (SNL)]. In the present study, we examined the rate and magnitude of LP that aggravates neuropathic pain. We measured pain-related behaviors [number of paw lifts to von Frey hair (VFH) stimulation] in awake rats after SNL or CCI surgery, and found that rates of decompression >/=5 hPa/h and >/=10 hPa/h and magnitudes of decompression >/=5 hPa and >/=10 hPa augmented pain-related behaviors in SNL and CCI rats, respectively. These results indicate that LP within the range of natural weather patterns augments neuropathic pain in rats, and that SNL rats are more sensitive to LP than CCI rats.

Lowering barometric pressure aggravates mechanical allodynia and hyperalgesia in a rat model of neuropathic pain.  [LINK]

Neurosci Lett. 1999 Apr 30;266(1):21-4.

Sato J, Morimae H, Seino Y, Kobayashi T, Suzuki N, Mizumura K.
Department of Neural Regulation, Research Institute of Environmental Medicine, Nagoya University, Japan.

To examine the effects of meteorological change on the pain-related behaviors of neuropathic rats, animals with a chronic constriction injury (CCI) to the sciatic nerve were exposed to low barometric pressure (LP), 20 mmHg below the natural atmospheric pressure in a climate-controlled room. CCI caused a decreased hindpaw withdrawal threshold to von Frey hair (VFH) stimulation (mechanical allodynia) and prolonged duration of hindpaw withdrawal in response to pinprick stimulation (mechanical hyperalgesia). When the CCI rats were exposed to LP, both these pain-related behaviors were aggravated, whereas no change was seen in a group of controls. In the CCI rats sympathectomy inhibited this LP-induced augmentation of pain-related behaviors. These results show that LP intensifies the abnormalities in the pain-related behaviors of neuropathic rats, and that sympathetic activity contributes to the LP effect.
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