16-01 Segment 1: How weather causes pain

 

Synopsis: Millions of Americans suffer pain as a result of weather changes. Experts discuss different conditions affected by weather, why pain responds to weather changes and possible remedies to some of these maladies.

Host: Reed Pence. Guests: Deni Cantrall, retired teacher and arthritis sufferer; Dr. Robert Jamison, Professor of Anesthesia and Psychiatry, Brigham and Women’s Hospital and Harvard Medical School; Bob Smirbeck, Expert Senior Meteorologist, AccuWeather.com; Dr. David Borenstein, Clinical Professor of Medicine, George Washington University School of Medicine and Health Sciences; Dr. Vincent Martin, Professor of Medicine and Director, Headache and Facial Pain Program, University of Cincinnati.

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Weather And Pain

Reed Pence: Every day, millions of Americans flip on the radio or jump online to find out the weather forecast. But some people don’t have to do that.

Deni Cantrall: Because I can feel it coming three days ahead of time. Where it’s coming from the west I can feel the pressure zone wearing on my knees, my ankles, my elbows, my everything.

Pence: Retired teacher Deni Cantrall has arthritis, and says her forecasts are just about 100 percent accurate.

Cantrall: I could have told you yesterday what was coming in tonight. And it’s actually here, I believe it’s rain.

Pence: Now, some people say that’s an old wives’ tale and that it’s only coincidence if a person’s joints appear to accurately predict the weather. But researchers say not so fast.  

Dr. Robert Jammison: We all might have an Aunt Minnie or an Uncle Fred who would just complain about the weather changes. I think, unfortunately, some people who don’t experience chronic pain and wouldn’t understand it, they tend to minimize it, or maybe they put it down to just complaining. So I guess it’s helpful for some people who do experience this to be reassured that they somehow didn’t invent this or are somehow imagining it.

Pence: That’s Dr. Robert Jammison, Professor of Anesthesia and Psychiatry at Brigham and Women’s Hospital and the Harvard Medical School. His study looked at more than 500 chronic pain patients, many of them suffering from arthritis, in four cities scattered across the country.

Jammison: Sixty-eight percent of the people that we polled said they were absolutely convinced that changes in the weather affected their pain. Most people would say that they can actually tell when the weather’s about to change. So it must be related somewhat to barometric pressure. But they also say that cold rainy conditions affect their pain as well.

Bob Smirbeck:  There’s still a little bit of controversy in the research, but there has been some research that proves your body reacts to changes in atmospheric pressure.

Pence: Bob Smirbeck is an expert senior meteorologist at Accuweather.com. Along with day-to-day forecasts and climate information for individual areas, the website also tracks the daily risk of all sorts of weather-affected health conditions, including allergies, respiratory conditions, colds and flu, migraines and arthritis pain.

Smirbeck: If you think about it, our body is mostly water. Within that water you’re going to have some gas pockets as well and atmospheric pressure can have a main influence on the fluids inside our bodies. If we have tissue surrounding our joints that have a lot of fluid in them and you can imagine if pressure starts to fall, there’s less force holding these tissues in place and they start to expand, and when there pressure falls, and when the pressure rises, they contract just like a balloon would when you blow into balloon and it expands and the air  comes out it contracts. Expansion and contraction of these tissues around our joints can cause pain, especially when they grow or they become inflamed so to speak, due to low pressure, so they grow and put pressure on our joints. Your aunt may in fact know that it’s going to rain because she’s a barometer, and she’s just felt the barometric pressure get lower and the way she knows that is her knee hurts, and that’s how she would know that in fact it’s going to rain.

Pence: That’s rheumatologist Dr. David Borensteen, clinical professor of medicine at the George Washington University School of Medicine and Health Sciences. He says while most people may not feel any difference, whether the barometer is high or low, the effects of atmospheric pressure can be profound.

Borensteen: If you go out in space where there is no atmosphere and you don’t have a space suit, you’ll explode because the pressure inside your body will expand you. So, just think what happens when you go from 31 inches of pressure to 29, let’s say a hurricane. Well, suddenly the atmosphere’s gotten much lighter and you expand. Now, when you expand it’s sort of the same thing that happens when you get on an airplane. A lot of people take off their shows and lo and behold they try to get them back at the end of the plane trip and they have trouble. Suddenly they’re all swollen. There was lighter pressure in the plane. The same thing can happen in individuals who have arthritis and their joints may swell.

Pence: Borensteen says people don’t even have to have arthritis to be affected. Often, an old fracture may do the same thing when the barometer’s dropping. But if low atmospheric pressure is to blame, does that mean that people living at high elevations with less air weighing down on them are miserable most of the time? Borensteen says no. It’s the change in pressure that’s important, once you get used to where you live.

Borensteen: So the people in Denver who live there don’t actually notice it, because their pressure may be a little lighter because they’ve actually been in the mile high city for a while. But when you first get there you might notice a little something because it is different. But once again, once you stabilize at that pressure the symptoms of my aching usually will go away. So it’s the change in the pressure that did it, not the fact that it stayed standard.

Pence: Other people advise moving to a warm climate to avoid arthritis pain. But Smirbeck says Accuweather tracks the arthritis pain forecast for those areas just as much as in the cold, snowy north, because again, it’s the small, relative changes in temperature as well as pressure that make for pain.

Smirbeck: Y’know everybody says San Diego has the best climate. They have a normal high around 70, normal lows in the 50s. Right in San Diego year round. When there are subtle changes in the weather, smaller changes, people in San Diego notice it more with their aches and pains. If you’re having aches and pains and you’re living in northern climates and you think you can move to the south, it may initially help you out, but your body will adjust to that climate you’re in, and if you have arthritis and you’re in the north and you move south, you’re probably still going to end up with arthritis once your body readjusts to the climate.

Pence: However, while arthritis flare-ups may be the most well known condition triggered by weather, there are plenty of others. The ones Accuweather tracks. For example, migraine headaches.

Dr. Vincent Martin: Imagine putting like a hot poker through your eye and enduring that kind of pain, but in addition to that there’s two other components to the migraine. One is you get these sensory changes, so you’re sensitive to both light and sound, much like a werewolf. So you have to withdraw into a dark room. If that’s not enough then you get nausea and vomiting, so you get these GI side effects as well. So you get this triple component. Which if those three components is most disabling to an individual patient depends on the patient.      

Pence: That’s Dr. Vincent Martin, professor of medicine and director of the Headache and Facial Pain Program at the University of Cincinnati. He says that overall, about 12 percent of people have migraines, but women are affected much more often. By the age of 40, one in four women get migraines. Often, they come only after a trigger. One of them is apparently lightning.

Martin: There are some people in whom they are only triggered by lightening than other weather variables. So that’s the only trigger they have. There are other people that have a potpourri of triggers. So they might have, for example, if the patient is female, they may have a headache around their menstrual period that occurs for one of two days, and then other people can have various dietary triggers like caffeine and monosodium glutamate, MSG, nitrates, etcetera, so it really depends upon the patient. If they are primarily weather driven, they could be up as high as an 80-90 % likelihood of having a headache on a given day certain with meteorological conditions.    

Pence: Martin’s study determined that if lightning struck anywhere within 25 miles of a migraine or chronic headache sufferer their risk of a headache could go up by about a third. But how soon that happens after the trigger varies.

Martin: The problem is often times with many triggers there can be a lag period of anywhere from, could either be an hour, a few minutes, but it could even be up to a day or day and a half or maybe even two days after a patient’s exposed to a trigger. That may vary by person. So some people may trigger very early after a lightening strike or weather change, or other people may not trigger for a day later.    

Pence: There are a whole variety of theories as to how lightning may trigger migraines. Martin believes electromagnetic effects are responsible. Others posit that an ion exchange, or stirring up of pollutants or allergens, could be triggers. But no matter which one is actually responsible, the important thing is that we now know for sure that lightning is a trigger. For some people, it increases the likelihood of a headache to about 75 percent.

Martin: Our goal would be to develop a model that helps to predict migraine. I can tell you in certain parts of the country, I live in Cincinnati, for example there are weather changes occurring every other day, or maybe every third day. If you’re sensitive to weather, particularly during very turbulent months like March and April or maybe during the fall, I wouldn’t be surprised if weather couldn’t be triggering 5-10 migraine attacks per month. So, we think that these weather changes, including lightening could be some of the most provocative and frequent triggers that migraine patients are exposed to. Now, when you take that one step further if that indeed is true, that 5 or 10 attacks could be triggered by weather changes during a given month, then there could be certain preventive strategies, migraine patients could take, namely they may take a certain medication just on those days in which they’re susceptible and they wouldn’t have to take it during other days, so it’s a paradigm shift in how we could potentially treat migraine.

Pence: A lot of migraine sufferers may also want to consider preventive action if they have allergies that are acting up. Another of Martin’s studies has linked allergies and hay fever to more and more severe migraines.

Martin: Allergies and hay fever are very, very common. Allergies and hay fever, depending on which study you look at range anywhere from about 20-40% of the population. Allergies and hay fever commonly co-occur in patients with migraine. In fact, about 60% of migraine patients have symptoms of hay fever. If migraine patients had hay fever or allergies, there was about a 30% excess risk of having a migraine attack, so the migraines were about 35% more frequent. In addition to that they were about 25-30% more disabling. So not only were they more likely to occur, when they did occur they were much more likely to be impactful, so they were more likely to miss social events, more likely to miss work, and so forth. So it seems to be a rather important factor in migraine patients.

  Pence: You’d expect that if there’s a connection between allergy misery and the onset of a migraine headache sufferers could prevent a lot of pain by effectively dealing with their allergies. And Martin has found that that’s true.

Martin:  We did a study published in the journal Headache where we looked at patients with what we call allergic rhinitis, which is hay fever, basically. If patients had hay fever and migraine and they were on allergy shots, particularly if they were less than 45 years of age, they had about a 50% less likelihood of having migraine attacks and when they did have them they were 50% less disabling. So that data suggested that if you dampen down the immune response associated with allergies that there may be actually preventative affect of those therapies. In addition, there have been other studies that have looked at nasal steroids or like sprays that you spray up in the nose when you have allergic symptoms like hay fever, and what they found was that they can reduce the amount of pressure in the sinus region by giving nasal steroids.

Pence: So it’s no old wives’ tale. It’s completely possible that your headaches can be a reliable pollen, ragweed, or even lightning detector. Our bodies react to changes in the weather, so it should be no surprise that when Aunt Minnie says it’s going to rain, she’s usually right.

You can find out about all of our guests on our website Radiohealthjournal.net.

I’m Reed Pence.

 

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