As a health professional, you want your patients to be happy and healthy this summer. There are seasonal activities to enjoy and social engagements to cherish, but what if the heat is doing more harm than good? While the cold is well known for its ability to increase pain, a rising temperature can also result in discomfort. In essence, as the mercury skyrockets your patient’s pain can, too. Let’s take a look at reasons why, for some, summer isn’t a time for relaxation, but instead, a time where their pain increases and tips on how to avoid these painful triggers.
Three Reasons Why Pain Increases in Heat
1) Heat hyperalgesia
Research has shown that warmth can calm tender joints and soothe painful areas. You’ve likely advised your patients to opt for a heat pack or a temperate bath to relieve pain. While this approach is well loved and effective for some; excessive heat can trigger trouble for others.
The study Why Pain Gets Worse: The Mechanism of Heat Hyperalgesia notes, “with all the other senses, the perceived intensity decreases with continuous exposure to a constant stimulus. Pain, on the other hand, cannot be ignored as it often signals tissue damage.”
Hyperalgesia, an increased sensitivity to pain, is not intrinsic to our pain-sensitive nerve terminals. Instead, when tissue is damaged, it is the release of extracellular pro-inflammatory mediators that cause pain. These mediators include bradykinin and nerve growth factor (NGF), both of which can reduce the threshold for the detection of discomfort.
This can be detrimental to those with chronic pain. As the external temperature increases in the summer heat, so can the patients suffering.
2) Inflammation and heat activated ion channels
In chronic, painful conditions like osteoarthritis, rheumatoid arthritis, chronic back pain, and multiple sclerosis, the ongoing tissue damage sets up the continual release of extracellular pro-inflammatory mediators. As mentioned above, these are integral to pain generation. The sensitivity of the heat-activated ion channel, transient receptor potential vanilloid 1 (TRPV1), is reduced by inflammatory products and is strongly activated when the temperature soars above 109.4 °Fahrenheit.
Water is essential to life. That’s a given. This ubiquitous fluid transports nutrients to cells and wastes from them. It ensures nourished blood, enzymes, and hormones, promotes cellular metabolism and enables the chemical reactions that are required for us to exist, and contributes to the varied lubricants that ease biological friction. Water supports our very structure and it absorbs heat to beautifully balance our body temperature.
To be without it can harm our bodies and foster pain. As the hot weather sets in, our bodies need to maintain a healthy temperature. To do this, we sweat. If insufficient fluid replacement occurs, dehydration results. Research has shown that mild dehydration is associated with increased baseline pain sensitivity, catastrophization, and pain sensitivity. In addition, headaches may be a result and migraines may be prolonged.
Older adults are particularly susceptible to dehydration, so it’s important to have an honest discussion with your elderly patients about how to remain adequately hydrated.
Being hot and dehydrated also results in exacerbation of physiological strain and mood disturbance. This may have a dual action, increasing pain through elevated physical stress and the reduced mental outlook that often exacerbates pain.
Which Clients Are at Risk?
While hot weather can increase pain in general, there are a number of conditions that may increase this risk further, including those with:
Studies have confirmed what patients report; those with arthritis can really feel the shifting temperatures. The older woman who says the rain is coming because she can feel it in her bones is simply stating a fact: Weather instability can hurt. Higher humidity has also been linked with increased pain and stiffness.
2. Chronic back pain
As a health professional, you’ve likely witnessed how hot spells and accompanying dehydration can increase back pain in those who suffer chronically. As Dr. James J. Lehman, Chiropractor, noticed, in a hot Albuquerque summer, those with “back pain were negatively affected by not drinking enough water every day.”
3. Multiple sclerosis (MS)
According to the MS International Foundation, up to two-thirds of MS sufferers report pain, including back pain, burning sensations in the extremities, headache, and cramping or spasm. For many, the hot or humid weather makes this worse.
4 Helpful Tips to Ease Heat-Related Exacerbation of Patient Pain
With these three reasons for increased heat-related pain, plus the at-risk conditions in mind, it’s important to know how to appropriately advise your patients to reduce their susceptibility. These four simple tips will help.
1. Stay hydrated
As we’ve discussed, adequate hydration is crucial. As one would expect, the required intake depends on activity levels, health, and age. According to the paper, Hydration: Fluids for Life, between the ages of 19 and 50 years, the average man needs approximately 13 cups of fluid per day, including drinking water. The average woman requires around 9 cups.
2. Avoid extended sun exposure
With a raging summer sun in the sky, an easy way to reduce heat exposure is to stay indoors during the peak hot hours of the day. Save outdoor visits for earlier in the morning, later in the day, and brief necessary visits when the sun is burning strong.
3. Remain active in altered surroundings
Being active is important for health and sensible activity is helpful for those with pain. But where a long, leisurely stroll through the open air or an outdoor workout might take a patient’s fancy in the fall, moving to an inside location is better for pain sufferers in the summer. This will help to avoid the pain-exacerbating effects that heat can bring.