Britain is in the grip of this winter’s first major cold snap, and for millions living with aches and pains that means one thing: even greater discomfort.
Colder winter weather has long been associated with increased pain and immobility.
Surveys show up to 75 per cent of those with chronic pain from illnesses such as osteoarthritis (age-related wear and tear on the joints that affects around ten million people in the UK) and rheumatoid arthritis (where a faulty immune system attacks the joints) believe plummeting winter temperatures heighten their suffering.
Research shows that even period pain can become more severe during cold weather – a problem dubbed ‘winter period fatigue syndrome’ by some experts.
The US study, published in the International Journal of Environmental Research and Public Health, found that period pain was greater when temperatures were lower in winter, at 18C indoors compared with a balmier 23C.
What’s more, the study found that eating ice cream or drinking cold water – especially in winter – seemed to heighten women’s pain.
It is thought that cold temperatures stimulate the release of hormone-like compounds called prostaglandins in the womb, which in turn trigger muscle contractions that lead to painful menstrual cramps.
But while evidence for the cold’s impact on periods might sound compelling, with long-term arthritic pain or back ache, for example, the picture is more nuanced.
Britain is in the grip of this winter’s first major cold snap, and for millions living with aches and pains that means one thing: even greater discomfort
For while weather conditions do seem to impact symptoms, rigorous scientific research has consistently failed to establish a clear link between tumbling temperatures and an increase in pain.
‘The jury is out in terms of cold weather and pain,’ says Dr Kirsty Bannister, an associate professor of pain neuroscience at Imperial College London.
‘Certainly when it comes to conditions such as osteoarthritis or rheumatoid arthritis there is 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, carried out in 2019 by the University of Manchester.
The study traced 13,000 people in the UK with long-term, painful diseases such as arthritis and fibromyalgia (characterised by pain throughout the body).
Participants in the experiment – which ran from January 2016 to April 2017 – used a smartphone app to log 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 levels of reported pain.
This flies in the face of a mountain of anecdotal evidence linking cold with increased pain – so why have so many people come to think that cold makes their chronic pain worse?
One theory is that nerve endings in the skin which sense pain can be activated by a sharp drop in temperature.
This explains why our cheeks and ears often sting when we step outside in freezing weather. It’s the nerves reacting to the environmental change, rather than any underlying increase in pain due to illness, that causes this discomfort. Yet people associate this change with pain.
‘My arthritis patients frequently report that their pain is worse in the cold,’ says Dr Benjamin Ellis, a consultant rheumatologist at Imperial College Healthcare NHS Trust in London. ‘But it doesn’t necessarily mean that their condition has deteriorated or that their arthritis has got worse. Instead, it’s more about the way the central nervous system is responding to the cold weather.’
Intriguingly, the researchers from the University of Manchester did find a correlation, with many respondents noting their pain got a lot worse when the weather was damp, and – even more puzzlingly – on days when strong winds were blowing.
Such weather conditions were found to increase the chances of participants reporting increased pain by about 20 per cent, with pain scores higher on damp, cold days than on dry, cold days – suggesting it was the dampness, not the temperature, that was key.
Low atmospheric pressure means the weight of air on the body is reduced, allowing muscles, tendons and other tissues in and around the joints to expand. This then increases the pressure on already-damaged joints, causing a spike in pain
But how could strong winds possibly add to pain levels even when people are sitting inside their own homes?
The Manchester team said they think this is less to do with the wind itself and more to do with the fact that windy weather is usually accompanied by changes in atmospheric pressure.
Low atmospheric pressure – which tends to create damp and windy weather – means the weight of air on the body is reduced, allowing muscles, tendons and other tissues in and around the joints to expand.
This then increases the pressure on already-damaged joints, causing a spike in pain.
Another possible explanation is that atmospheric changes lead to 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 fluid’s lubricating properties, also adding to the pain. Studies have suggested chemicals called cytokines involved in pain sensation may be affected by changes in pressure, too.
The Manchester research isn’t the first to make this connection to low pressure. A 2019 study in Norway, involving 48 people with fibromyalgia, found that low atmospheric pressure (i.e. cloudy, wet and windy weather) was associated with increased pain.
Meanwhile, studies in those with rheumatoid arthritis have found they experience less tenderness and swelling in their joints when the weather is sunny and less humid – possibly because air pressure is higher and so tissue inside joints does not expand.
In a report on their findings the Manchester researchers said: ‘We found temperature did not have a significant association with pain – whereas the other components did. Our results might mean cold is merely associated with the other components [i.e. damp and windy weather] and that they are the primary mechanism for increased pain.’
The bad news is that this means simply staying indoors is unlikely to solve the issue, as air pressure is largely the same inside or out.
And it’s not just joints and muscles in the firing line: changes in atmospheric pressure (such as when a storm is brewing) are known to bring on migraines, possibly by triggering chemical or electrical changes in the brain.
But another factor to explain the perceived connection between ‘cold and pain’ is that as temperatures dip, we spend more time indoors and less on physical activities. Yet regular light exercise is known to be one of the best ways to cope with the pain of some conditions.
‘There is definitely a placebo effect involved,’ says Dr Bannister. ‘People often expect extreme temperatures to cause more pain – it’s something many associate with winter months.’
The social isolation caused by the long, dark winter nights can worsen mood – which, in turn, is known to worsen pain.
Dr Bannister says: ‘People tend to stay in and become socially isolated, which can have a huge impact on our response to pain.’ So one way to ward off worsening pains in winter may be to accept more social invitations to go out.
Other simple tips include:
- Apply a hot water bottle or microwavable wheat bag to stiff, achy joints. The heat dilates blood vessels, improving blood flow and so soothing pain.
- Take a brisk 15-minute walk. The more muscles contract, the more heat they generate.
- Heat your home to at least 18C to reduce the risk of cold-induced pain, says the NHS.