What Harvard's Study That Claims There's 'No Relation' Between Rain and Pain Missed
Sometimes the news isn’t as straightforward as it’s made to seem. Erin Migdol, The Mighty’s chronic illness editor, explains what to keep in mind if you see this topic or similar stories in your newsfeed. This is The Mighty Takeaway.
For many people with chronic illnesses, rain and pain are inextricably linked. Storm clouds gathering? “Get ready for a flare,” you might think. Feeling an increase in pain you weren’t expecting? Look outside — yep, it’s raining.
So when a Harvard University study published in The BMJ last week that claimed no correlation had been found between rain and pain levels began circling the internet, I was surprised. “The weather is not causing joint pain,” the lead author, Anupam B. Jena, told the New York Times. “The rain, it’s plain, has no effect on pain,” touted a Boston Globe headline about the study.
This finding contradicts what so many in the chronic pain community say, especially at this time of year. Could it be possible that the connection between rain and pain is just a myth?
After looking more closely at the study, I found some serious flaws in its assumptions of how people respond to pain — assumptions that sadly illustrate the reality of chronic pain even scientific researchers don’t seem to understand.
The problem is the way researchers attempted to track how much pain the study’s participants felt during and after rainy days. Researchers looked at Medicare patients with joint or back pain caused by chronic conditions (rheumatoid arthritis, spondylosis, invertebral disc disorders, and others) and whether they made appointments with a general internist on rainy days. They also tracked whether these people made appointments in the weeks following intense rain, and whether they talked about pain in previously-scheduled appointments that happened to fall during a rainy period.
“We hypothesized that if a true relation between rainfall and joint or back pain exists, patients might be more likely to either acutely seek care from their internists for these conditions during rainy periods or mention these symptoms when seeing an internist during a previously scheduled outpatient visit,” the study says.
The data showed no correlation between these doctors’ visits and rain.
But here’s the thing: people who deal with pain frequently may not even make a doctor’s appointment when they’re in pain.
Chronic pain is just that — chronic — meaning people with chronic pain live with a certain amount of pain every day and simply can’t go to the doctor every time they’re in a pain flare. Few people have the time, energy or money to go to a doctor’s appointment every time the pain gets bad. It’s even more unlikely when you consider how difficult it often is to make a doctor’s appointment in the first place (as anyone who’s had to schedule an appointment far in advance because of the doctor’s busy schedule knows).
Chronic pain patients know that seeing a doctor doesn’t necessarily mean you’ll get help for your pain. Pain is not easy to treat, and doctors don’t have all the answers. Especially with so many doctors feeling pressure to limit opioid prescriptions, chronic pain patients may not believe going to a doctor during a pain flare will even help — so why make an appointment?
People with chronic pain also usually have their own techniques that help them deal with pain flares at home. Hot baths, heating pads, TENs units, medication and even little things like cozying up in bed are all in a pain warrior’s arsenal. The study’s participants may not have made doctor’s appointments because they knew they have strategies they could try on their own. Pain is, quite simply, a part of life they’ve had to learn to deal with.
Other research into the effects of weather on pain has been mixed, though slightly favoring the hypothesis that weather affects pain. A British project called “Cloudy With a Chance of Pain” asked people with chronic pain to enter their symptoms into an app and found that reported pain levels went up during rainy periods. It’s fairly well-accepted that changes in barometric pressure can affect pain levels (low pressure is associated with storms and higher pain). However, a pair of Australian studies measured weather changes like temperature and humidity against patients’ surveys about their pain and found no association.
Clearly, this field of research needs further study and can’t be boiled down to a simple “true” or “false” conclusion just yet. And it’s possible this is a very individual issue — some people may be affected by weather, and some may not. But to make any assumption about pain based on whether or not a person visited a doctor is misguided.
Many pain patients called out the study’s flaws on social media:
JUST BC WE DON'T GO TO THE DOCTOR MORE FOR PAIN ON RAINY DAYS DOES NOT MEAN WE DON'T HURT MORE. SAME DAY APPOINTMENTS AREN'T EASY TO GET AND WE OFTEN JUST "LIVE WITH" OUR PAIN. WE CAN'T GO TO A DOC EVERY TIME WE HURT – THAT IS ABSURD AND EXPENSIVE. https://t.co/vZKuX31ll7
— Kelsey (@kelseyhardin_) December 21, 2017
I think anyone who wants to study if weather affects pain should focus on patients’ pain levels and the patients themselves. I never contact my doctor when weather affects my pain. There’s no point – they can’t do anything and by the time I see them the weather will have passed.
— Kate Mitchell (@kmitchellauthor) December 22, 2017
No, this study is not disproving the rain/joint pain anecdote. (Who gets appointments same day for joint pain? You take appt regardless of weather.) https://t.co/8g1I5uOIos
— Bryn Robinson (@brynphd) December 15, 2017
Whoa! Such a flawed study! They only studied internists. Who goes to an internist for pain from rain?
What they should’ve studied is how many patients cancel appointments on rainy days lol.
— kat (@graphickat) December 22, 2017
I always report that I have more pain and migraines when there is a barometric pressure shift (rain or not), but I just suffer through it, as most of us do.
— Rie Lopez, MPH (@RieOfLetters) December 21, 2017
1. I know where rain is and what direction it’s coming from about 50 miles out. My skin burns worse, and the pain kicks up. It’s my superpower.
2. This study had a crap design. We spoonies don’t go when weather is bad. We don’t tend to go anywhere. Pain’s too bad. https://t.co/97yS3mSJML
— Carina Hilbert (@CarinaHilbert) December 22, 2017
One indicator of where Harvard’s study went wrong could be this paragraph, found just before the Results portion of the paper:
No patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for the design or implementation of the study. No patients were asked to advise on interpretation or writing up of results. There are no plans to disseminate the results of the research to study participants or the relevant patient community.
Researchers need to include patients when they’re developing their studies. Chronic pain is not easy to understand from the outside looking in because healthy people who don’t experience pain often tend to react to pain differently. Someone without chronic pain may very well make a doctor’s appointment if they experience a bout of pain during rainy weather. But people with chronic conditions, who deal with pain constantly, may not. Without consulting patients themselves, scientists will continue to make assumptions that don’t represent patients’ true experiences.
Ultimately, Harvard’s study shows that people aren’t making doctor’s appointments for rain-related pain. At the end of the paper, researchers acknowledge that “an association may still exist” and larger, more detailed data would be useful. Hopefully, future research will incorporate the ways real patients actually interact with pain and the medical system. Scientists can’t expect to answer the big questions about pain without understanding what it’s really like to live with chronic pain.
Getty photo by pavrich