Chronic pain is missing from America’s heat warnings

When a scorching heat wave descends upon a region, standard public health guidance typically includes advice such as staying hydrated, recognizing signs of heat stroke, and checking in on individuals with pre-existing heart or lung conditions. While these recommendations undoubtedly save lives, they overlook a critical aspect that significantly impacts the daily lives of millions of older Americans: chronic pain.

A recent study conducted by public health professor Kai Zhang and the author followed over 35,000 adults aged 50 and above across two decades, correlating their reports of chronic pain with the temperature history of their neighborhoods. The study aimed to determine if prolonged exposure to extreme heat or cold impacts whether chronic pain interferes with people's lives.

The findings suggest that chronic pain should be an integral part of how the nation prepares for extreme weather events, and that rural residents may be the most vulnerable. High-impact chronic pain is defined as pain lasting at least three months that limits a person's ability to perform daily activities, such as working, socializing, and self-care.

This type of pain is not occasional aching but rather a persistent, debilitating issue that directly influences decision-making. For individuals over 50, high-impact chronic pain is a leading reason for losing the ability to live independently. Working in extreme heat, particularly for farmers and ranchers, is difficult for those experiencing chronic pain.

Temperature affects the body in various ways that can lead to pain: cold increases pain sensitivity and stiffens joints, while heat affects the body through dehydration, disrupted sleep, and the shrinking of a person's willingness to engage in daily activities. The most dangerous aspect of heat waves often stems not from the afternoon peak temperature but from the excessively hot nights that fail to provide the body with ample recovery time.

The study revealed two significant findings. Firstly, among the one-fifth of participants who experienced numerous extreme-cold days, reports of high-impact pain increased. However, those encountering occasional cold spells did not exhibit the same effect; their bodies seemed to adapt to a single harsh winter, but adapting becomes increasingly challenging over multiple years of extreme cold.

Secondly, the connection between extreme heat and the development of new high-impact pain differs based on geography and wealth. Urban residents experiencing sustained heat showed no link to developing new chronic pain, while rural residents faced a stronger association. This disparity may be due to rural individuals spending more time outdoors working or residing in older homes that are harder to cool and have limited access to cooling options.

Additionally, among the poorest older adults, sustained heat was associated with a higher likelihood of developing high-impact pain, while the wealthiest were unaffected, likely due to better access to air conditioning, healthcare, and the ability to avoid heat exposure. The study highlights three crucial lessons for assisting older adults.

First, chronic pain should be included on lists of heat-related health risks. Currently, state and county heat plans typically flag cardiac and respiratory patients but often overlook those whose independence depends on managing chronic pain. With advance warning, individuals can plan and seek help, knowing that their chronic pain might worsen.

Second, cooling assistance programs must be tailored to the unique needs of rural areas. Traditional weatherization, energy assistance, and delivery methods through trusted local channels that rural homes require are necessary, rather than offering standard services.