Association between rainfall and diagnoses of joint or back pain: retrospective claims analysis
BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5326 (Published 13 December 2017) Cite this as: BMJ 2017;359:j5326
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I read through the article and as soon as I had read the title, I knew the results of the findings without reading further. There will be no strong influence of RAINFALL on joint or back pain, however, there WILL be a stronger correlation between barometric pressure and both relief from, and increase in, pain.
I believe that if the authors were to look at the complaints and review the barometric pressure (which may have stabilized on the rainy day that the patients were seen by their doctors) for the previous 48 hours there will be a much stronger correlation of pain and a fall in the barometer. And, thus, a corresponding decrease in joint pain when the barometer is rising.
When the barometer starts to fall, there is often a corresponding ache in sensitive joints (and backs, though I have no experience with this). The body takes time to "catch up" to the barometer. But it does equilibrate. So, if the barometer is falling on Sunday and the rain starts on Monday but the barometer has stabilized at a lower atmospheric pressure on Monday at 0400 hrs, the patients joints may have already "caught up" to the outside pressure and compensated, giving a pain free office visit.
So, if the original question was " Does rainfall correlate to joint and back pain?" the answer is "no", because the rain itself is not the cause of the pain. It does not hurt to shower or swim. It usually feels better to be floating in a pool rather than walking up steps.
I believe that stretch receptors in the tissue surrounding, and inside of, the joints are the cause of the aching pain. Think of the knee joint. Think about what we know about pain and stretch receptors. After surgeries, the incision site is painful, but if the swelling is removed there is significantly less pain. The edematous tissues are painful because they are being stretched. (One of the reasons that a CPM will decrease pain in a post op joint. Motion causes a decrease in swelling and a decrease in pain.)
Example: The barometer is falling and the atmospheric pressure and the body spaces have been at a stable place for several days or weeks. Now, weather is coming. The outside pressure has fallen and the body must now compensate, but this is not immediate. Initially the decreased pressure outside will allow the tissues internally to swell outward, until the body finds equilibrium. So, you have pain on the day the barometer moves (it may not be raining yet, but its coming!). The next day, when it is rainy - the barometer may have stabilized and there is little if any pain. And if the rain lasts for several days and the barometer stays put, the pain goes away. As the barometer rises, the relative pressure inside the body decreases (because it is being compressed, decreasing the size of the joint capsule) and the pain goes away completely leaving the patient feeling as if they were younger again. Less pain, less stiffness.
So, if the question truly was "Does rainfall affect joints in a painful manner?" then the question is answered. But I feel the question of " Does the weather affect my joints?" has not been answered.
The question should be asked again and further investigation, using the barometer as the antagonist, instead of rain, then the answer may be quite different.
Thank you for putting up with my discussion.
Doug Kautz, PA-C
Rochester, MN
Competing interests: No competing interests
I read with interest the article by Anupam B Jena, Andrew R Olenski, David Molitor, and Nolan Miller, "Association between rainfall and diagnoses of joint or back pain: retrospective claims analysis". I am particularly pleased with their use of big data as learning from our electronic records is one of the promises of medical informatics. For many years I have entertained a hypothesis that patients with chronic joint or back pain are more likely to cancel or not show up for appointments on rainy days. I only had anecdotal support for this but Figure 2, provided by the authors, seems to show a trend in this direction. It doesn't appear to be statistically significant but might be interesting for a follow up study. When I have asked patients about this, the response is often, "Oh, I was too ill to see the doctor."
Competing interests: No competing interests
I am sorry to say that I believe that the Premise of your study was flawed. You have assumed that a person with Joint changes that are associated with changes in the weather, would go to a Doctor.
Why would I go to a Doctor for a change in the weather? Do you assume that a person would want medication to alleviate their discomfort?
Better that you study the effect of a dropping barometric pressure on the gas within joints. As Rain does not cause anything, better to have characterized it as barometric pressure related. (I have found no such relationship but I have not studied large numbers of subjects).
And remember, just because both Ice Cream sales and Murders increase during the Summer, that does not mean that one causes the other.
Competing interests: No competing interests
The study has confirmed that outpatient visits for joint and back pain are unrelated to rainfall but the reported association remains. Chronic pain of this type as experienced and reported fluctuates in intensity day to day and is affected by many factors in the biopsychosocial model. Patients will only attend an ‘outpatient’ appointment for planned review, perhaps, or an acute severe exacerbation i.e not much of the time. In the title - ‘feeling it’ - is apposite and reflects the emotional aspect of the unpleasant sensation. It is not a stretch to relate increase in pain experienced (and reported) on rainy days (and with inclement weather in general) to the mood changes that would be expected. Ascertaining the veracity of this would require diaries and psychometrics which would be impossible to blind. Pain is what the patient says it is and I remain happy to accept that the level in the individual (n = 1) may be influenced by weather conditions.
Competing interests: No competing interests
The reason why Jena and colleagues have failed to find an association between joint pain and rain is simple. They have been looking at the wrong variable – and to my knowledge no-one has looked at the right one.
Joints tell you where they are by virtue of the proprioceptors around them. You know where your hand is even if your eyes are shut by virtue of this, and proprioceptors are sensitive to changes in pressure. They are, in effect, baroreceptors.
Damage a joint and the receptors become more sensitive. Sensitive, or sensitised proprioceptors can detect changes in the atmospheric pressure. When in Greece, the Canaries and so on the weather is settled; joints don’t hurt when the atmospheric pressure is not changing, but they will detect change and so tell you when a front is approaching. It doesn’t matter whether the pressure goes up or down – it’s the change. So you become your own barometer. While rain is often associated with weather fronts it also occurs when the atmospheric pressure is stable.
The research that needs to be done, therefore, is to look at the pattern of joint pain compared to the change, and particularly rate of change in atmospheric pressure. This could be done by asking patients with sensitive joints to rank their symptoms day by day, or even more frequently, and comparing these changes with meteorological data on barometric pressure. Such data are readily available nowadays. On an individual basis anyone with a multi-function weather station could collect local data themselves.
I do not need to do this. I dislocated my shoulder years ago and can tell the weather by it. The effect has dimmed over time, and now I only get shoulder pain with a precipitate weather change, so I am good in the hurricane season.
Competing interests: No competing interests
In this article regarding the temperature changes due to rains is not mentioned.I have developed a hypothesis in 1982 that when the temperature goes down the space in the joints especially knee joints get reduced like the railings in railway tract gap between summer and winter and so the gap in the joint is responsible for the development of pain as per the description. This is very much applicable in India because of the difference in temp in summer and winter are extremes and hence the pain is more perceptible in our day today practice. So, any study should take into account regarding the temp changes and also difference in temp between summer and winter and not rainy season as mentioned in your article and is a wrong study especially related to Rheumatoid Arthritis.
Competing interests: No competing interests
Earlier today I sent an email to the Corresponding Author of this report. Basically I concurred with another comment which said that few people with joint pain they think is associated with coming storms, see a medical professional about it. I also said that a proper investigation would have to include, not only the people who don't see doctors about this, but a time-stamped correlation with a barometer placed near where they experience these symptoms, to look at the correlation with falling barometric pressure, not rainfall. I've already heard from two TV reporters in my city who agreed with my opinion that these people don't usually go to doctors about this. I'm sure there are many other people who share these opinions. I hope to hear from the Corresponding Author about my email before too long.
Competing interests: No competing interests
This analysis misses a crucial piece of data that makes the conclusions invalid. There is no exact date known of the start of the pain or substantial increase in pain. Authors estimate that date to be the date of reporting to the clinic or a week backwards. Visiting of an out-patient clinic is not the same as an emergency visit. The date of incidence of the health event and date of the visit to the clinic are completely uncorrelated. Therefore nothing can be inferred from the date of visit of when the event took place.
This vital missing data makes the whole conclusion invalid.
Competing interests: No competing interests
I am not a medical researcher, but good grief, there is such a glaring flaw in this data. No matter how large the sample, there are two major factors not considered:
1) Lag time between onset of weather related joint pain and actual physician visit due to scheduling, etc.
And more likely - 2) Most people do not visit their physician for this level of pain. It's annoying and can interfere with normal activity but it's not worth running to the doctor. Most self medicate with OTC drugs.
This seems so obvious.
Competing interests: No competing interests
Re: Association between rainfall and diagnoses of joint or back pain: retrospective claims analysis
This analysis lacks several key pieces of data that influence the validity of the data collected. Anecdotal reporting of joint pain due to air temperature and seasonal weather changes are well documented and the lack of daily temperatures or the authors failing to pre-select a temperature range to sample data from creates additional variables that may influence patient pain irrespective of rainfall.
Furthermore, there is no criteria for the severity of pain and the actual onset of the pain question; was it enough to request immediate medical attention or was it incidental on the day of the scheduled appointment? Even with such large patient numbers missing these important pieces of data may make any findings incidental.
Competing interests: No competing interests