Chronic pain is missing from America's heat warnings

When a heat wave arrives, public health advice typically emphasizes drinking water, watching for heat stroke, and checking on people with heart or lung conditions. However, this standard approach overlooks chronic pain, a pervasive issue for millions of older Americans. A new study led by public health professor Kai Zhang followed over 35,000 adults over 50 across two decades, comparing their reports of chronic pain to their neighborhoods' temperature history.

The study aimed to determine whether living with extreme heat or cold changes the impact of chronic pain on daily life. The results suggest that chronic pain should be integrated into how the country prepares for extreme weather. Researchers define "high-impact chronic pain" as pain lasting at least three months that limits a person's ability to work, socialize, and perform self-care.

This type of pain is not occasional aching but significantly affects daily decisions. For adults over 50, chronic pain is a leading reason for losing independence. Temperature affects the body differently, leading to pain. Cold appears to increase pain sensitivity and stiffen joints, while heat affects the body through dehydration, broken sleep, and reduced willingness to engage in daily activities.

Heat waves are particularly dangerous due to the lack of a cooling period, leaving the body without recovery time. The study tracked neighborhood extreme temperatures, comparing each to its 10-year record. Communities facing many extreme-cold days showed increased reports of high-impact pain, while those with occasional cold spells did not.

Extreme heat had varying effects based on geography and wealth, with those able to avoid the heat least likely to report new chronic pain. Rural areas face additional challenges, such as older, harder-to-cool homes and higher energy costs. Rural hospitals closing also limit access to healthcare. The findings highlight three key lessons for helping older adults: rising global temperatures increasing the risk of extended exposure to extreme heat, the need to consider chronic pain in heat-risk planning and clinical assessments, and the importance of addressing housing and local climate conditions in heat-risk strategies.