Aches and Rains

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I'm Hannah Fry.

And I'm Dara O'Brie.

And this is Curious Cases.

The show where we take your quirkiest questions, your crunchiest conundrums, and then we solve them.

With the power of science.

I mean, do we always solve them?

I mean, the hit rate's pretty low.

But it's with science.

Welcome back to Curious Cases.

Dara, how are you doing?

I'm not doing well.

I brought the wrong coat.

Oh.

You know, the way you choose the wrong coat, this is like a perennial thing in my life.

And I know I could just open the door and walk into the cold and assess it there.

But no, I commit to a coat and I went too heavy.

And then you're stuck with it.

And then you're stuck with it.

And then you're like, you know, baking for the day or freezing.

In many ways, a year-round problem, I think.

It is.

It is.

And something that a 52-year-old man should really be across.

But it just irritates me.

It's God.

It's this ridiculous weather.

Too hot, too cold.

Yeah.

Well, interestingly, we actually have got a bit of a weather-related question.

No sartorial advice, though, unfortunately.

Oh.

But it came in from Anne Snell, two curious cases at BBC.crown UK.

I've listened to this.

Hi, I'm Anne from Canada.

And I was just wondering if aches and pains are related to the weather.

You know, when you're younger, you hear people saying, oh.

a storm is coming because my knees hurt.

You always think, oh,

the person's almost like talking about magic or voodoo or something.

It's like, oh yeah, there's something bad coming.

And you're like, what?

But now that I'm older, I am noticing joints aching, and sometimes I see a correlation, and I didn't know if it's coincidence or if it's something scientific.

What do you reckon then, Dara?

Do any of your body parts have a particular meteorological?

No, they don't, they don't, actually.

And I have a shunky knee, I've mentioned this a couple of times, but it doesn't start aching like whatever.

It's something I always associate as an old wise tale.

Like somebody will go, oh, my back is hurting there'll be rain my hips can sense mist on the horizon yes it's an interesting question because it it's one of those things that has endured the notion that somehow it affects your your bones in particular thing is though is that you know i think when those kind of rumors do endure there's often something to them there are definitely some that are going to be better and worse depending on the weather.

It's just the bone thing.

Yes, I get that, you know, this kind of knowledge didn't arrive by chance.

The one I always feel is the, you know, people go mad on a full moon where in fact a full moon is just brighter so therefore it's easier to commit crime in a kind of pre-lit civilization so therefore more stuff happened under a full moon it's very difficult to commit crime when you're basically working in pitch black complete darkness you keep walking into things but then the full moon comes and like and you can see whose cattle you're supposed to be rustling or whatever so that's always my slight worry about it like the uh and also because I've literally never met anyone in modern life who goes oh oh be backs at me oh, that'll be the rain.

It just feels like it's always somebody who's heard that there was a person who did this.

Okay, so we're going to see where this lies then on the spectrum between cattle rustling and actual legitimate science.

Yes.

We're not going to settle for voodoo magic on this show, basically.

We have got three people this week to help us to get to the bottom of things.

Will Dixon is a professor of digital epidemiology at the University of Manchester and author of the excellently named study, Cloudy with a Chance of Pain.

And Dr.

Chris Wallace is is a statistician at the University of Cambridge who has looked into how seasonality affects our genes.

We also have with us Professor Trevor Harley, a psychologist with a particular interest in how the weather affects our health.

And you've actually come up with your own job title.

Am I right, Trevor, for this?

Well, I do like to call myself a psychometeorologist, and there aren't many of them around.

That's sort of the way Ghostbusters started as well with a title like that.

What does a psychometeorologist do?

I'm interested in how the weather affects all behavior, but mainly human behaviour.

And it affects us in many surprising, but often subtle ways.

It affects health, it affects mental well-being, and it affects the way we behave on a day-to-day basis.

These broad range of effects, I mean, they're in human history as long as we've had recorded human history, presumably.

That's right, and the weather has affected history, and the weather has affected human behavior all the time.

And of course, In the past, people used to be outside much, much more.

In an agricultural society, people are out exposed to the weather all the time more recently we've been living indoors and so the effects are smaller but they're still there living indoors i think brings its own problems because exposure to sunshine in particular is good for us of course it's got its downside too with skin cancer but and aging affects the skin but the sun is also good for us okay and now in terms of weather affecting behavior what are the major findings The most well-known is the effect of temperature on behaviour.

When we get too hot, it has many effects effects on us.

It has dehydration, it has stress, it affects our emotions.

And generally, when people get hot, they tend to become more impulsive, angrier, and more violent.

And we observe that as the temperature increases, particularly as it gets hot and humid in the summer, we find things like violent crime goes up, rioting goes up,

sex crimes go up, even things like road rage increases, and you tend to see more violent behaviour on sports pitches.

So, I think the effect of temperature and behaviour is the most profound.

But the other things are sunshine.

Sunshine is good for mood, and we observe that most strongly with seasonal affective disorder.

So, okay, I can definitely see that, like, in general, I can imagine being much grumpier when I'm too hot.

I'm on board with that.

But, of course, there are different places in the world which have different temperatures as sort of standard baseline.

So, i mean how much of this can be down to the temperature itself i mean are we saying that everyone in ireland is grumpy all the time because it rains too much well it isn't rain it's the temperature itself of course rain has its own downside and upside and in fact the smell of rain on soil and the release of geolosmin actually elevates mood so rain isn't all bad But the thing about rain is that when it's rainy, it can't be sunny.

And I think that's the main effect of rain.

It's not the rain itself, it's the lack of sunshine.

And as I've said, sunshine is good for us.

But you're right, there are obviously all sorts of confounds.

First of all, as we go to warmer climates like the Mediterranean, things like the diet are different, social settings and the importance of the family are different.

And so we have to take all these things into account.

For example, when it's very hot in summer in Britain, there's more people outside together.

People might consume more alcohol outside and those things are going to have effect.

But there are laboratory studies that show that as ambient temperature goes up, people tend to become angrier and irritable.

Because I did, just because I knew this topic was coming, a back of an envelope looked to the history of rioting in this country.

And you have to go back to 715, the riots, they were in June, 766, the food riots were in August, 1958, they were in August, 1981, they were in July.

2001, they were in July, and June and May.

2011, they were in August.

And the riots in 2024, in July.

They're always pretty much, there are exceptions, obviously, the Poltex riots were in March, but pretty much the history of rioting in Britain is a history of summer.

And it's people rioting in the warm weather.

Yeah, that's right.

It goes right back to the Peterloo massacre and the Peterloo riots were in August too.

And not only were they in August, but they've been a particularly hot August for that period.

And we don't just see it in Britain, we see it across the world.

It's interesting because obviously that doesn't mean that's not the reason riots happen.

I mean, they're all would point to different

factors, but it is an unusual, you know, pattern to observe

observe that this is almost like that's the thing that dries the tinder.

It's not a cause, as you say, but it's a facilitator, it's the thing that kind of pushes people over the edge in some cases.

Well, a lot of what we're going to talk about would be cold weather.

I think we were presuming it would be cold weather we'd be talking about here, and cold weather affecting people's joints.

And so, if cold is bad and warm is bad,

what's the ideal ambient temperature for us to live peacefully?

21 degrees centigrade.

That's the perfect temperature.

Is there such competence?

Does the evidence back this up?

Yes, it does.

It does.

And that corresponds to the perfect summer's day.

Less so now, but it used to be the case that when the sun is shining and it's 21 degrees, that's when I'll be at our optimum.

And in your study, have you found that people say it hurts more, they have more pain when it's warmer or cold?

Yes, people do really think that the weather has a big effect on pain and it does have some effects.

The problem is that it's a very subjective thing if someone says to you that you're in pain you can hardly say no you're not it doesn't generally go down very well so if they say they're in pain they are and people associate pain with temperature and rain but the problem is that they might not be the actual causes people might be attributing something to that temperature or rain when in fact it might be something else for example humidity and also these effects tend to be quite small.

Some studies have found it, others haven't.

And therefore, you need large, robust studies to get the real effects.

Talking of large, robust studies, that's the most perfect segue ever, Will, into your work.

Because actually, there has been some work into this before that have been small studies, right?

That's right.

Well, we reviewed the literature on this and found 43 studies that had looked at the relationship between musculoskeletal pain and the weather.

And as Trevor was saying, the findings were all very inconsistent.

And they were inconsistent because they studied it in lots of different ways.

They studied different populations, different types of joint problems.

They studied the weather in different ways.

They might have assumed that people were exposed to the weather where they lived.

Some studies were small, some studies just measured the pain and the weather at one moment in time and not through time when you get the changes to the weather.

And in fact, across those 43 studies, the only consistent finding across them was that pain was not associated with the direction in which the wind blew.

Amazing.

Amazing.

So you can't tell, the northerly wind, you can't tell.

You can't.

I mean, there is a lot of stuff going on here, though, right?

Because, I mean, pain in itself is a subjective experience.

How you feel about different temperatures, presumably, is also a subjective experience.

I mean, not everybody universally likes the same conditions.

So, how on earth do you try and unpick some of those things?

Well, you're right that pain is subjective.

Some people are more stoical than others.

People may report that their pain is very bad all of the time or very good all of the time.

But the benefit of being able to track pain through time is that you can look at moments at which pain increases for somebody and then compare that to times where the pain hasn't increased like that and look at the differences between the weather in those two points in time.

Like a person becomes their own control group or something.

Yes.

Exactly.

That's exactly right.

Okay, so how do you do that then?

Is that what you've done?

Yes.

So we ran a study a few years ago called Cloudy with a Chance of Pain.

We recruited 13,000 people across the country who downloaded an app and then they tracked their symptoms every day over a six-month period.

And then we used the GPS within the phone to link to the local weather data so that we could find those moments at which pain increased and compared them to moments which it didn't and compared the weather at those times.

Okay, so we'll come on to the findings in a second.

But were you extremely smart the day that you came up with that pun?

It's my career highlight.

I hear the words cloudy with the I think of meatballs because I've read that book too often and seen that film too often.

So I've got pain doesn't rhyme with meatballs.

He's made a mess of that.

I mean is there something that rhymes with meatballs we could change it to just for the purposes of Darwin Brian?

Yeah there is sore no that's not

so anyway apologies.

What did you discover then from all these people?

What we found was that there was a relationship between the weather and pain and within the weather, the thing that was most strongly associated was humidity.

And we also found a relationship with low pressure.

Just remind us, for those of us who aren't completely au fait with the meteorological connections, low pressure, what does that mean to the weather outside?

Well, the changes in atmospheric pressure tend to precede the changes that we feel and experience.

So, a cold weather front might move in with low pressure, so it might bring rain, it might bring a change from cold weather to sunny spells.

So, it was the low pressure that was linked.

And in fact, that makes sense to me as a doctor because patients will so regularly say to me, I think I can predict the weather based on my pain.

I can tell it's going to rain because I can feel it in my hip.

And the only thing that they would be experiencing in the weather today that might then relate to the weather to come is the pressure.

So it's not so much that it's like rain equals more pain, it's that the change in weather equals more.

Well, as Trevor was saying, you experience the weather but there's lots of different ingredients to the weather so there's pressure there's humidity there's sunshine there's rainfall and all of these are linked in some way making it quite hard to analyze as a as a research question but yes it was the humidity and the pressure that we found that was linked although patients do say often that it's the cold and the and the wet, the rain, that they've found a link.

Can I ask about the pressure though?

If people are saying a change in pressure, a drop in air pressure essentially gives them a sensation in their hip or their joints and then they wrongly say this is predicting the weather because they're actually just sensing the pressure changing.

Do they report the same thing when they go into an airplane?

Some patients do, yes.

So the patient partner who was part of the project, she has an inflammatory spine problem.

She often told us that when she goes up in an airplane she can feel her symptoms differently.

Because that is substantial drop in pressure, to half an atmosphere of pressure like this.

Equally if they went scuba diving, I'm not sure these people are doing, what a lifestyle these people are having, but if they get off the plane, they go scuba diving.

So, all of those pressures surely will be even more pronounced.

So, we can see a correlation there.

Yeah, you'd expect that to be true, yes.

But why, though?

So, why would pressure make a difference?

Well, we don't really understand that.

Our study didn't look at the causes, it just tried to find whether there was an association or not.

But by discovering that, we can hopefully hand back to other researchers to discover why is that causal relationship exist and therefore is there anything that you can do about it that might influence people's pain in the future.

Do you think these are separate mechanisms then, pressure and humidity, do you think that they're like separate and distinct or do you think that they're kind of coming hand in hand?

I don't think we know.

I don't know.

Okay, are we sure that it's not just that people expect to feel bad?

That's a good question.

And at the start of our study, we were very clear that we wanted to try and unpick some of these potential complexities.

Sunshine can make you feel happy and if you have a good mood, then you may report less pain.

So, within the study, we measured not just the weather and pain, but also things that we thought might affect that relationship.

So, whether you'd spent much time outside that day, so were you exposed to that weather at all.

We measured mood, we measured physical activity.

So, if it's a sunny day, do you go out and do more activity, which then leads to more pain?

And so, we adjusted for these things in the analysis, and we found that the relationship between the weather items that I mentioned and pain held true even if you adjusted for mood and physical activity.

Did you also adjust for whether whether people had been writing that day?

We did not know we've omitted that variable.

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Chris, I want to bring you in here because you've got to be underpinning this relationship between weather and pain.

And you found that it might be our genes that are responsible.

Yes, as a group, one of the things we do is we try and understand the mechanisms behind disease by comparing the activity of genes in people with a disease to people without a disease.

And a student on one of these studies asked a very good question.

He said, well, what happens to the clock genes across the year?

So the clock genes are genes that change their activity during the course of 24 hours.

They help us know when to feel tired, when to wake up.

And we know these clock genes are partly trained by the amount of daylight, because if you mess with the amount of daylight, you mess with their regular 24 activity.

So we looked in our study what happens to these clock genes across the year when the amount of daylight is changing.

And they changed.

Throughout the year, they had this, this, I'm waving my hand, which isn't helpful, they had this sinusoidal pattern where some of them were up in winter and some of them were up in summer.

And then we looked more closely what are the genes that are up in winter, up in summer.

And the ones that were up in winter had this kind of inflammatory profile, which interests us because we work on inflammatory and immune diseases.

And then we looked more closely at the cells in our samples and we found that actually the mix of immune cells in our samples was also changing throughout the year, such that the cells that were up in winter are the things that I would call like the first responders.

They're the cells that patrol your body looking for these microbial invaders.

They're ready to defend you.

And these were up in winter, which gives you your inflammatory profile.

Let me make sure I understand this then.

So, okay, winter comes, at which point your body's like, there's going to be loads of viruses around.

We need to up the up the game here.

And so, the number of cells that your body has ready to respond to that kind of system is already increased.

That's our hypothesis because we checked that these people didn't have active infections when we studied them.

So, these were people without infection, but they seem to be ready to fight an infection.

So, yeah, our hypothesis is somehow your body is anticipating

additional winter is coming.

Yeah.

And

so it's preparing you to fight these invaders.

And does this not because of temperature, not because necessarily pressure, does this because of hours of sunlight?

Sunlight is certainly part of it because we know for sure that sunlight controls these clock genes and we know that some of these clock genes are like master regulators.

They control the activity of other genes.

The link between some of these clock genes and the number of these particular cells in our body, that's also been shown in mice.

So, certainly, daylight is part of it.

I'm not going to say it's all of it.

Certainly, the profiles we saw correlated with temperature, with pressure, with rain, because these also vary seasonally throughout the year.

So, your body basically knows that it's going to be winter somehow, possibly to do with sunlight,

and then changes literally the number of cells that you have that are there to fight off infection as winter arrives.

Yeah, crazy.

It's pretty cool.

And we're not totally sure we know how it does it.

Well, I'm not totally sure.

Certainly, someone somewhere might be, but not me.

But when you say inflammation, I hear that as a very bad thing.

The body is already fighting something else.

The body's in pain.

The body is, you know, inflammation is the thing that we want to avoid.

Well, inflammation is your body's response to injury or pain, right?

And you need the inflammation.

You need that response in order to fight the infection.

You need that response in order to heal the injury.

But chronic inflammation is certainly not something we want.

It's associated with worse health outcomes.

It's associated with cardiovascular disease, heart attacks.

So you can see why we don't have this constantly high ready-to-fight infection profile because that would come at a cost.

So somehow the body has learnt that it's worth being more ready in winter.

but then decreasing that readiness in summer.

In terms of inflammation when it's working well, I mean, if it's like a physical increase in volume, I suppose that is what you're describing, right?

This physical increase in the number of actual cells.

Well, inflammation, you feel it as swelling, which is what you're talking about, the increase in volume.

It's also heat, because there's energy there, and you feel it as pain.

So I think that's how we link back to what Will's study was talking about.

So this process?

This process you would feel as pain?

Yeah, because the inflammation, it's swelling.

Swelling presses on the nerves, it causes pain.

So in preparation for a possible attack, your body enters a painful state.

I suspect that we don't all feel more painful all the time in winter.

It's a small effect, right?

It's it's not that we all go into extreme pain every winter, but it's it's enough that I suppose in patients with an active inflammatory disease like arthritis, it could switch their disease activity to higher.

So, we could be back to the issue of joints and people's joints hurting because of this.

This, I think, could pre-programme you.

I don't know that anyone who's looked at season and pressure together to try and disentangle the two.

You guys, this could be the start of a really important club, actually.

Talk.

Chris, can I just ask, as we travel around the globe, different places have different ratios of sun depending on the time of year?

So, this effect you're talking about, if someone lives in the equatorial region, this disappears?

Yes.

So, we did look.

The first thing is when we saw this pattern in Europe, we asked, well, what about Australia?

And we went and found people in Australia who had some data we could use, and we asked, and you saw the complete inverse.

The genes that we saw up in our winter are up in their winter, which is July.

Yes.

Then we spoke to someone I know who had a study in the Gambia, which isn't quite on the equator, but it's near it, it has a tropical climate.

And they had a totally different pattern.

They have a pattern where their increase in inflammatory cells, because we weren't looking at genes in their study, we were looking at these cells, were up in their rainy season, which is when the infection burden is highest with malaria and so on.

Ah, so you'd evolve, I suppose, depending on where you are, to your body would learn to react to an imminent threat.

Well, it means that you're not reacting strictly to daylight, right?

Because their daylight isn't lowest in their rainy season, right?

Their rainy season is towards the summer.

But that's when the infection is high.

I guess the rainy season will be lower pressure, though.

When are you flying to the Arctic Circle?

When are you taking a trip to Svalbard?

I'm not inclined to cold weather, so

you'll send somebody else.

When are you sending a junior press it up to poking and product people in northern Norway?

Because

that's the interesting extremum case.

Well, we did look at Iceland, which is quite north.

It wasn't a very large study, but we couldn't find the sinusoidal pattern.

And we hypothesised it's because it just gets too dark and things break down.

But we weren't really sure.

Sinusoidal here, we should say, is is going up and down over time.

Yeah, it's that nice shape that you

for a few years.

Yeah, a wave.

Wave shape, that's the S car.

But not for the people of Iceland.

They get none of that.

They're just so extreme it breaks.

The wave crashes.

We didn't see any seasonality in Iceland.

I mean also though, people haven't been in Iceland that long, right?

A thousand years or so?

Yeah, give them a chance to really get used to the area.

People haven't been in Australia that long, but they're responding to the signals.

Well, I mean, people have been in Australia that long but probably the people we've been studying haven't been in Australia that long.

Okay I want to come back to you well.

What do you make of all of this?

Do you think that these sound like good potential reasons for our ability to sense pain differently depending on the weather?

I mean I think it all sounds plausible.

I mean you talk about seasonal affective disorder and being related to light and you see that very clearly in clinical practice that patients coming into clinic will say that they're a bit more miserable with the weather and then they come back in the summer and describe how it's better.

You have to try and unpick what that's due to and is it due to the light but then there are other types of studies that support that.

I mean looking at interventions like light boxes and seeing improvements can support that.

I mean the way that you're sort of describing

houseplants with slightly more complicated emotions, you know, like we're

sensitive to light, sensitive to pressure, sensitive to humidity.

I mean these are things that I didn't even really notice that we were picking up on.

No, well, that's true.

I mean, I think we're sensitive to lots of things, and we have to try and find what are the most important things that we are sensitive to.

When I look after people who have long-term conditions, they spend a lot of time trying to work out what are the triggers that makes

them worse.

So for diseases that flare through time, people are constantly trying to work out, is it something I ate?

Was it to do with my stress or my mood?

Was it to do with my physical activity patterns?

And lots of people are trying to work that out so that they can then take action or even just understand what it is that's influencing their disease.

But I guess to unpick this, this is why you have to do these large-scale

studies, because you're never going to find an effect.

There's too many things to find an effect on 30 or 40 people.

Well, one of the very interesting things about all of these questions is that they've been around a long time.

People have wanted to know the answers, but the data that we have to study them has often been inadequate.

And in some of those examples that I was describing, they're behaviours or their environmental exposures that change continuously through time.

So the weather's changing day to day, it's even changing within the day.

Your symptoms are also going up and down day to day.

So what you're trying to do when you're working out what is the trigger is that you're trying to piece back together what is it that you were exposed to?

What was the weather?

What was the diet?

What was your mood?

And then relate it to these symptoms that are also going up and down through time.

And data sets tend not to collect that level of of granularity or kind of accuracy.

But as soon as you stick a smartwatch on somebody, it becomes much easier.

Well that is a big opportunity for population health research as well as for clinical practice as well.

In my clinic I tend to see people say once every six months and my opening question to them is how have you been in the last six months?

Give me one data point.

It's the hardest question to answer and yet if you can track people's symptoms you can get a clearer picture of how they've been allowing us to make better clinical decisions and the same's true when we're trying to understand these causal relationships in populations tracking symptoms tracking diet tracking physical activity gives you the data that you can then analyse to try and work out does a lead to a change in b well okay does this make a difference then can you actually use this information to impact people's pain in the long term other than just saying move to the south of Spain?

Well quite a lot of people do ask me if I can prescribe them a move to the south of Spain.

I mean I think for weather it is difficult isn't it because you can't change the weather but when we spoke to our patients and research study participants we said well why are you doing this?

Why does it matter?

And they said well first of all it's good that I know that I'm not making it up because there were all of these studies before and nobody really knows the answer.

So proving that there is a true relationship, patients found really helpful.

People were also interested in being able to forecast what their pain was like.

So you can see that low pressure is moving in on Thursday.

And if that were to relate to increased pain, you might plan your week accordingly.

When I mentioned this topic to a urologist I know, she went, oh yeah, of course, absolutely.

Over active bladder, people will wee more during cold weather.

So other fields have had this as well, but this is the same as a lot of you talk about it.

We all seem very vague about the mechanisms of this.

It seems to be still a gap in this increasingly accurate wives' tale of, you know, know, my knee can protect the weather.

Sometimes those odd wives' tales do just get dismissed as that.

That's just anecdote.

I can hear some patients say it, but there's no proof.

So generating the proof that there's a relationship is the first step.

Then working out how can you intervene to make changes is sort of the next.

And proving that those interventions help will be the next thing.

Well, okay, then we've got somewhere.

Not quite an old wives tale, but not yet.

No, I was expecting you to dismiss this way more than you you have it seems to be there's there's a lot of substance this so you can go and complain more when it's a bit cold outside that's what i'm finding yeah you can but if it's really warm outside you can really kick it off

well okay all that remains is to thank our guests today will dixon chris wallis and trevor harley

That's sort of one of those nice topics, isn't it?

Where it's like we're just beginning to know something.

Yeah, I was genuinely expecting us to end up dismissing something as being wealth useless, not the real connection.

And it turns out there totally is.

I mean, I was raising my eyebrow a little bit about the 21 degrees thing, but you know, but mostly.

Every thermoset of my life from here on is going to go to 21 degrees.

And when people complain, as people will complain, I'll go, no, that is the correct temperature.

Scientifically proven.

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