Britain is experiencing the first major cold snap of this winter, and for millions of people living with aches and pains that means one thing: even more discomfort.
Colder winter weather has long been associated with increased pain and immobility.
Surveys show that up to 75 per cent of people with chronic pain are due to conditions such as osteoarthritis (age-related wear and tear of the joints affecting around ten million people in the UK) and rheumatoid arthritis ( where a defective immune system attacks the joints). They believe that falling winter temperatures increase their suffering.
Research shows that even period pain can become more severe during cold weather, a problem called “winter period fatigue syndrome” by some experts.
The US study, published in the International Journal of Environmental Research and Public Health, found that menstrual pain was greater when temperatures were lower in winter, at 18°C indoors compared to a milder 23°C.
What’s more, the study found that eating ice cream or drinking cold water, especially in winter, seemed to increase women’s pain.
Cold temperatures are thought to stimulate the release of hormone-like compounds called prostaglandins in the uterus, which in turn trigger muscle contractions that cause painful menstrual cramps.
But while the evidence for cold’s impact on periods may seem compelling, in the case of long-term back or arthritic pain, for example, the picture is more nuanced.
Britain is experiencing the first major cold snap of this winter, and for millions of people living with aches and pains that means one thing: even more discomfort.
Because while weather conditions appear to affect symptoms, rigorous scientific research has failed to establish a clear link between low temperatures and increased pain.
“In terms of cold weather and pain, there’s no jury,” says Dr. Kirsty Bannister, associate professor of pain neuroscience at Imperial College London.
“Certainly when it comes to diseases like osteoarthritis or rheumatoid arthritis, there’s no good data to support it.”
In fact, there are other elements of winter weather that could make a difference, revealed a major study on cold snaps and pain, conducted in 2019 by the University of Manchester.
The study tracked 13,000 people in the UK with long-term painful conditions, such as arthritis and fibromyalgia (characterized by pain throughout the body).
Participants in the experiment, which ran between January 2016 and April 2017, used a smartphone app to record their pain scores, while a GPS tracker on their phones recorded changes in the weather.
The results, published in the journal NPJ Digital Medicine, showed no clear correlation between cold conditions and reported pain levels.
This flies in the face of a mountain of anecdotal evidence linking cold to increased pain; So why have so many people come to believe that cold makes their chronic pain worse?
One theory is that nerve endings in the skin that sense pain can be activated by a sudden drop in temperature.
This explains why our cheeks and ears often itch when we go outside in freezing weather. It is the nerves reacting to environmental change, rather than any underlying increase in pain due to illness, that causes this discomfort. However, people associate this change with pain.
“My arthritis patients frequently report that their pain is worse in the cold,” says Dr Benjamin Ellis, consultant rheumatologist at Imperial College Healthcare NHS Trust in London. ‘But that doesn’t necessarily mean that your condition has deteriorated or that your arthritis has worsened. “Rather, it is more about the way the central nervous system responds to cold weather.”
Interestingly, researchers at the University of Manchester found a correlation: Many respondents noted that their pain was much worse when the weather was wet and, even more disconcertingly, on days when strong winds were blowing.
Such weather conditions were found to increase the odds of participants reporting an increase in pain by about 20 percent, with pain scores higher on wet, cold days than on dry, cold days, suggesting it was humidity, not temperature, the key.
Low atmospheric pressure means that the weight of air in the body is reduced, allowing the muscles, tendons and other tissues in and around the joints to expand. This then increases pressure on the already damaged joints, causing increased pain.
But how is it possible that strong winds increase pain levels even when people are sitting inside their own homes?
The Manchester team said they believe this has less to do with the wind itself and more to do with the fact that windy weather is often accompanied by changes in atmospheric pressure.
Low atmospheric pressure, which tends to create humid and windy weather, means that the weight of air in the body is reduced, allowing muscles, tendons and other tissues in and around joints to expand.
This then increases pressure on the already damaged joints, causing increased pain.
Another possible explanation is that atmospheric changes cause a thickening of synovial fluid, a liquid inside our joints with the consistency of egg white that reduces friction between bones. This thickening reduces the lubricating properties of the fluid, which also increases pain. Studies have suggested that chemicals called cytokines involved in the sensation of pain may also be affected by pressure changes.
The Manchester research is not the first to establish this connection with low pressure. A study conducted in Norway in 2019, involving 48 people with fibromyalgia, found that low atmospheric pressure (i.e. cloudy, humid and windy weather) was associated with increased pain.
Meanwhile, studies in people with rheumatoid arthritis have found that they experience less tenderness and swelling in their joints when the weather is sunny and less humid, possibly because the air pressure is higher and therefore the tissue within the joints Joints do not expand.
In a report on their findings, the Manchester researchers said: “We found that temperature had no significant association with pain, while the other components did.” Our results could mean that cold is simply associated with other components (i.e. humid and windy weather) and that they are the main mechanism of increased pain.’
The bad news is that this means that simply staying indoors is unlikely to solve the problem, since the air pressure is virtually the same inside as outside.
And it’s not just joints and muscles that are in the line of fire: changes in atmospheric pressure (like when a storm is brewing) are known to trigger migraines, possibly by triggering chemical or electrical changes in the brain.
But another factor explaining the perceived connection between “cold and pain” is that as temperatures drop, we spend more time indoors and less time engaging in physical activity. However, regular, light exercise is known to be one of the best ways to cope with pain from some conditions.
“This is definitely a placebo effect,” says Dr. Bannister. “People often expect extreme temperatures to cause more pain; it’s something many associate with the winter months.”
Social isolation caused by long, dark winter nights can worsen mood, which, in turn, worsens pain.
Dr Bannister says: “People tend to stay at home and socially isolate, which can have a huge impact on our response to pain.” So one way to prevent pain from getting worse in winter may be to accept more social invitations to go out.
Other simple tips include:
- Apply a hot water bottle or microwaveable wheat bag to stiff, sore joints. Heat dilates blood vessels, improving blood flow and thus relieving pain.
- Take a brisk 15-minute walk. The more the muscles contract, the more heat they generate.
- Heat your home to at least 18C to reduce the risk of cold-induced pain, the NHS says.