Though many people believe in the connection between weather and health, the medical evidence is unclear.
Reviewed By Brunilda Nazario
Many of us have an older relative who claims to have an arthritic joint with the power to tell the future, at least meteorologically. She will stare out the window on a perfectly pleasant, sunny day, distractedly rubbing her painful shoulder, and proclaim solemnly, "A storm's a comin'."
She's hardly alone in her belief. The idea that certain painful health conditions are affected by the weather is both widespread and ancient, dating back to at least Hippocrates in the fourth century B.C and no doubt earlier, according to James N. Weisberg, PhD, a psychologist who specializes in treating painful conditions.
But despite the venerable pedigree of the belief, should we ditch our Doppler radar and our well-groomed television meteorologists and replace them with Achy Joint Bulletins issued by our great aunts?
Probably not. Although many believe in the connection between weather and health, most medical studies have come up with equivocal support at best. So if there isn't a connection, or if the connection is relatively unimportant, why do we believe in it so strongly?
As a science, human biometeorology studies the relationship between atmospheric conditions and people. There are of course all sorts of indisputable and obvious connections between weather and health, such as the incidence of sunstroke on hot days or frostbite on cold ones, according to Dennis Driscoll, emeritus professor of atmospheric sciences at Texas A&M and a meteorologist who specializes in human biometeorology. There are also significant but less direct connections between weather and health, such as the onset of allergies during pollen season. In such cases, the atmospheric conditions are clearly affecting health, but they are playing more of a supportive role than a primary one, Driscoll says.
But some researchers are interested in looking at less direct potential connections between atmospheric conditions -- like temperature, barometric pressure, and humidity -- and painful conditions such as arthritis, fibromyalgia, and sinus or migraine headaches. The difference here is that the connections are not as obvious and the mechanism that would cause the symptom isn't known.
There is a seemingly endless supply of anecdotal evidence backing up the belief that weather can affect painful conditions like arthritis -- just ask some relatives at the next family picnic. Plenty of doctors see it as well.
"Most of my patients complain of pain on rainy days," says Gary Botstein, a rheumatologist practicing in Decatur, Ga. "A lot of them can tell you if a storm is coming based on their pain."
"Some of my patients are absolutely convinced of the connection," Weisberg tells WebMD, "and they run the gamut from people who are physicians themselves to those who never got beyond the eighth grade."
It's important to stress that doctors and researchers do not believe that weather actually makes arthritis or any of these diseases worse. Instead, the idea is that weather can affect your symptoms. But why would changes in the weather cause pain? No one is entirely sure.
The suspect most often singled out by arthritis sufferers and researchers is a drop in barometric pressure, which is the pressure exerted by the air around us. A drop in barometric pressure often precedes a storm, and the theory goes that a decrease in the air pressure can cause the tissues around the joints to swell, causing arthritic pain. Proponents of the idea use a balloon in a barometric chamber as a simulator. If the pressure outside drops, the air in the balloon expands. If the same happened in the area around an arthritic joint, the expansion or swelling could irritate the nerves, causing pain.
"It could be that the sensitivity of the nerves is so highly tuned to barometric pressure that they can respond to even minor changes," says Frances Wilder, PhD, an epidemiologist and the director of research at the Arthritis Research Institute of America in Clearwater, Fla.
However, it's important to note that this process is entirely theoretical because the swelling -- if it really is taking place -- is happening on such a small scale that it cannot be detected by any scientific means. Since there is nothing that can be charted medically, study of the subject is reliant on subjective accounts of arthritic pain, which are hard to compare from one person to another.
"It's not as if I've seen active changes in inflammation as a result of weather changes," Botstein tells WebMD, "and there aren't tests that would reflect such changes in inflammation on a day-to-day basis."
Driscoll sees a problem with the barometric pressure theory. "People need to realize that the pressure changes associated with storms are rather small," he says. In fact, he observes that the changes associated with a storm are about equivalent to what a person experiences in going up an elevator in a tall building. So far, there haven't been many reports of people with arthritis hobbled by elevator rides in the medical literature.
Despite the widespread belief in the connection, looking over the scientific studies of the relationship between weather and health makes two things apparent: The literature doesn't agree and there isn't all that much of it.
"The subject of pain and weather greatly interests patients, and it's amazing that it doesn't interest more researchers or clinicians in the United States," says Weisberg. "I have patients who talk about it with me every day."
Part of the reason for the lack of interest in this country probably lies in the fact that the studies haven't turned up much. Wilder and Weisberg themselves have both independently worked on studies that didn't show any striking connection.
"We have a problem here in the field of human biometeorology because so much of it is conditioned by what amount to old wives' tales and ancient beliefs that by and large have not been corroborated by scientific investigation," says Driscoll. "The weather has been blamed for everything from heart attack to hangnail."
Weisberg is similarly skeptical. "Everyone believes in this connection throughout the ages, but there doesn't seem to be real evidence for it," he says. "There have been anecdotal studies, a few case reports, a smattering of literature here and there. Interest in the subject perks up occasionally and then dies down when nothing is found."
There has been some work that showed a possible connection. Believers typically cite a famous study conducted in Philadelphia in the '60s by researcher John Hollander. In the study, Hollander isolated several patients with rheumatoid arthritis in a sealed chamber and gradually adjusted the atmospheric conditions. He found some evidence that swelling and stiffness increased with a rise in humidity and a drop in barometric pressure.
So since most studies of the connection between painful conditions and weather have not found meaningful results, why do people keep coming back to it?
Part of the problem with studying the relationship between weather and health is in the sheer number of possible atmospheric conditions -- including barometric pressure, temperature, humidity, precipitation, and so on -- and in the possible symptoms. There's also a great deal of difference in how people say they feel the weather relates to their pain. Some say the pain precedes a weather change, others say that they coincide, and still others say that it follows them. The variety of combinations may be one of the reasons that researchers keep returning to the subject. There's always that chance that the right combination of conditions or symptoms haven't been studied.
"I think the fact that this 'myth' has persisted far longer than many others makes me wonder if there really is something to it," says Wilder, whose recent study did not turn up any statistically meaningful connections between osetoarthritis and weather changes. "I think it's possible science hasn't caught up with the anecdotal evidence."
But Wilder agrees that the evidence is shaky and that other explanations are possible.
A Psychological Explanation
There are other possibilities for the apparent connection between weather and pain. For instance, Driscoll and Weisberg argue that people may tend toward gloominess on rainy days, and that their bad mood may make their pain more difficult to bear.
The possibility that psychology plays a role in shaping our responses to weather and pain doesn't mean that the pain isn't real or that weather isn't having an effect.. Weisberg speculates about the numerous indirect connections that could be made between weather and health; for instance, might a gloomy day make people unhappy and stay in bed longer, causing them to feel more stiff?
There may be deeper psychological processes at work. Everyone's been struck by a feeling of apparent clairvoyance when we happen to be thinking about an old friend who calls on the phone a few minutes later. What we don't remember are the countless times that our reminiscing doesn't result in that phone call.
Using this same logic, one instance of an arthritis flare-up coincidentally taking place before a storm might be all it takes for someone to become convinced that there is a direct connection between his or her symptoms and the weather.
"We want to find a reason for our pain, but sometimes we can't," says Weisberg. "And so the weather is one of the easiest things to blame." All you have to do is look up to find your suspect.
Driscoll agrees. "If you convince yourself that there is a relationship between the weather and your pain, then by golly, there is one," he tells WebMD. "As the barometer lowers, and the clouds approach, and the wind picks up, if you think that your arthritis ought to be acting up, it will."
Although Weisberg is generally a skeptic, he finds the desire to believe in the connection very strong even in himself. "I try to tell my patients that there really isn't evidence that weather has a big effect even if they think it does," he says. "But it's hard, because in the back of mind, there's still this strong feeling that there really is something to it."
The Silver Lining
Despite the failures by researchers to find a strong connection between weather and health, Driscoll notes that hope springs eternal. "And that's sort of ironic, because we certainly don't want the weather to be that effective in ordaining our illnesses," he says.
Despite the disagreements, almost everyone concurs that the effects of weather on chronic pain conditions is mild at worst and nonexistent at best. Either way, it doesn't matter that much.
Because of this, even if you have severe pain associated with the weather, experts recommend that you should be very careful before deciding to follow the folk wisdom and move to a climate that is drier and warmer. "I have patients who go down south for the winter and they feel great for the first few months," says Weisberg. "But then their body acclimates to that weather pattern and they start feeling just like they did before."
Besides, the possibility of environmental benefits to changing climates might be outweighed by the psychological stress -- and the physical pain that might develop as a result of that stress -- of reestablishing yourself in a new place, according to Wilder.
Weisberg and Driscoll offer some practical advice. "Since there's not much people can do about the weather. They should just work on the things that they can change," says Weisberg.
Driscoll agrees. "If weather has any influence at all on pain conditions, it's a very small one," he says. "And since we can't do anything about it anyway, why worry about it?"
Published June 9, 2003.
SOURCES: Gary Botstein, MD, rheumatologist, Decatur, Ga.; board member, Georgia Chapter of the Arthritis Foundation. Dennis Driscoll, PhD, emeritus associate professor, department of atmospheric sciences, Texas A&M. Pain, 61, 1995. Pain, 81, 1999. Neuroscience Letters, 266, 1999. Proceedings of the National Academy of Sciences, April 1996. Rheumatology, March 14, 2003. James N. Weisberg, PhD, associate professor of psychiatry and anesthesiology, State University of New York, Stony Brook. Frances V. Wilder, PhD, director of research, Arthritis Research Institute of America, Clearwater, Fla.
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