How the weather affects the pain of

citizen scientists using a smartphone

app
William G. Dixon; Anna L. Beukenhorst; Belay B. Yimer et al.

2019

This study has demonstrated that higher relative humidity and wind
speed, and lower atmospheric pressure, were associated with
increased pain severity in people with long-term pain conditions

Abstract
Patients with chronic pain commonly believe their pain is related to the weather. Scientific
evidence to support their beliefs is inconclusive, in part due to difficulties in getting a large
dataset of patients frequently recording their pain symptoms during a variety of weather
conditions. Smartphones allow the opportunity to collect data to overcome these
difficulties. Our study Cloudy with a Chance of Pain analysed daily data from 2658 patients
collected over a 15-month period. The analysis demonstrated significant yet modest
relationships between pain and relative humidity, pressure and wind speed, with
correlations remaining even when accounting for mood and physical activity. This research
highlights how citizen-science experiments can collect large datasets on real-world
populations to address long-standing health questions. These results will act as a starting
point for a future system for patients to better manage their health through pain forecasts.

Study subjects
2658 patients

Smartphones allow the opportunity to collect data to overcome these difficulties. Our study
Cloudy with a Chance of Pain analysed daily data from 2658 patients collected over a
15-month period. The analysis demonstrated significant yet modest relationships between
pain and relative humidity, pressure and wind speed, with correlations remaining even
when accounting for mood and physical activity
Findings
The odds of a pain event was 12% higher per one standard deviation increase in relative
humidity (9 percentage points) (OR 1.119 (1.084–1.154), compared to 4% lower for
pressure (OR 0.958 (0.930–0.989) and 4% higher for wind speed (OR 1.041 (1.010–1.073)
(11 mbar and 2 m s−1, respectively)

Scholarcy Highlights
 Weather has been thought to affect symptoms in patients with chronic disease since the
time of Hippocrates over 2000 years ago.[1]
 This study has demonstrated that higher relative humidity and wind speed, and lower
atmospheric pressure, were associated with increased pain severity in people with
long-term pain conditions
 The most significant contribution was from relative humidity
 The effect of weather on pain was not fully explained by its day-to-day effect on mood or
physical activity
 The ‘worst’ combination of weather variables would increase the odds of a pain event
by just over 20% compared to an average day
 The odds of a pain event was 12% higher per one standard deviation increase in relative
humidity (9 percentage points) (OR 1.119 (1.084–1.154), compared to 4% lower for
pressure (OR 0.958 (0.930–0.989) and 4% higher for wind speed (OR 1.041 (1.010–
1.073) (11 mbar and 2 m s−1, respectively)
 Such an increased risk may be meaningful to people living with chronic pain

Scholarcy Summary

Introduction
Weather has been thought to affect symptoms in patients with chronic disease since the
time of Hippocrates over 2000 years ago.[1].

Studies have failed to reach consensus in part due to their small sample sizes or short
durations; by considering a limited range of weather conditions; and heterogeneity in study
design.[5,6,7,8,9,10,11] Resolving this question requires collection of high-quality symptom
and weather data on large numbers of individuals

Such data need to include other factors potentially linked to daily pain variation and
weather, such as mood and amount of physical activity.

Collecting this kind of multi-faceted data in large populations over long periods of time, has
been difficult
Methods
Patient involvementPatient involvement has been important throughout the study, from
inception to interpretation of the results.

C.G. and other members of the Patient and Public Involvement Group were involved in
media broadcasts at study launch and subsequent public engagement activities, explaining
why the research question was important to them and relevant to patients with long-term
pain conditions.[22] They have supported the interpretation of findings and the
development of dissemination plans for the results, ensuring the results reach study
participants, patient organizations and the general public.

Results
Recruitment and retentionThe study app was downloaded by 13,207 users over the 12-
month recruitment period (Figs 1 and 2a) with recruitment from all 124 UK postcode areas.

A total of 10,584 participants had complete baseline information and at least one pain entry,
with 6850 (65%) participants remaining in the study beyond their first week and 4692
(44%) beyond their first month (Fig. 2b).

A total of 2658 participants had at least one hazard period matched to a control period in
the same month (Fig. 3) and were included in the final analysis.

There were 9695 hazard periods included in the analysis for the final 2658 participants,
matched to 81,727 control periods in 6431 participant-months.

A total of 1235 participants contributed one month, and the remaining 1423 participants
contributed 2–15 months

Conclusion
This study has demonstrated that higher relative humidity and wind speed, and lower
atmospheric pressure, were associated with increased pain severity in people with long-
term pain conditions.

The most significant contribution was from relative humidity.

The ‘worst’ combination of weather variables would increase the odds of a pain event by
just over 20% compared to an average day.

Such an increased risk may be meaningful to people living with chronic pain

Builds on previous work

Nonetheless, such an increased risk may be meaningful to people living with chronic pain.
In addition to investigating the weather–pain relationship, we successfully conducted a
national smartphone study that delivered on the promise of how consumer
technology can support health research.[12,15] This study recruited over 10,000
participants throughout the United Kingdom, sustained daily self-reported data over many
months,[13] and showcased the value of passively collected GPS data

It is possible that only people with a strong belief in a weather–pain relationship

participated, generating an unrepresentative sample. However, the percentage of
participants who believed in the weather–pain relationship was similar to prior studies,
[20] and we did not see selective attrition of people who reported no weather–pain
beliefs.[13]

C.G. and other members of the Patient and Public Involvement Group were involved in
media broadcasts at study launch and subsequent public engagement activities, explaining
why the research question was important to them and relevant to patients with long-
term pain conditions.[22]. They have supported the interpretation of findings and the
development of dissemination plans for the results, ensuring the results reach study
participants, patient organizations and the general public

Differs from previous work

In addition to investigating the weather–pain relationship, we successfully conducted a
national smartphone study that delivered on the promise of how consumer technology can
support health research.[12,15] This study recruited over 10,000 participants throughout
the United Kingdom, sustained daily self-reported data over many months,[13] and
showcased the value of passively collected GPS data. Prior large smartphone studies have
retained only around one in ten participants for seven days or less.[16,17] In contrast, our
study retained 65% of participants for the first seven days, and 44% for the first month,
with over 2600 participants contributing to the analysis having provided data for many
months of the study.[13,14] An important success factor was strong public involvement in
early setup and piloting, as well as participants’ interest in weather as a possible pain
trigger.[14]

Contributions
In summary, our large national smartphone study has successfully supported the collection
of daily symptoms and high-quality weather data, allowing examination of the relationship
between weather and pain. The analysis has demonstrated significant relationships
between relative humidity, pressure, wind speed and pain, with correlations remaining
even when accounting for mood and physical activity.

Limitations
There are potential limitations to this study. First, the reduction in participant numbers
from over 10,000 with baseline data to the final 2658 participants with at least one within-
month risk set raises questions about generalisability. Importantly, the characteristics of
those included in the analysis were similar to the initial 10,000 participants, other than
being slightly older (mean age 51 versus 48 years old). In a prior analysis, we showed that
Cloudy participants were largely representative of a population reporting chronic-pain
symptoms,[13] although proportionally fewer participants at both extremes of age were
recruited. However, we would not expect middle-aged recruits to differ in their relationship
between weather and pain from older or younger participants, and thus such selection
factors would not invalidate our results. Second, the study was advertised to participants
with a clear research question. It is possible that only people with a strong belief in a
weather–pain relationship participated, generating an unrepresentative sample. However,
the percentage of participants who believed in the weather–pain relationship was similar to
prior studies,[20] and we did not see selective attrition of people who reported no weather–
pain beliefs.[13] The within-person design would, regardless, mean that participants who
drop out early would not introduce bias from time-invariant characteristics. Third, the lack
of blinding raises possible information bias where observed weather could influence
participants’ symptom reporting. Our baseline questionnaire demonstrated that rain and
cold weather were the most common pre-existing beliefs. If a reporting bias were to exist,
we would expect higher pain to be reported at times of colder weather. Our findings—
including the absence of an association with either temperature or rainfall—cannot be
explained by such a reporting bias. Fourth, pain reporting is subjective, meaning one
participant’s “moderate” might equate to someone else’s “severe”. The within-person case-
crossover analysis meant we compared moments when an individual’s score increased by a
meaningful amount to a control period for that same person. Fifth, we chose to model the
weather using daily averages. It is possible that other findings may be hidden if the
association between weather and pain was with other metrics of weather, such as the daily
maximum, minimum, or range, or even if the changes in weather on hourly time scales
affect participants’ pain. Sixth, the findings from this United Kingdom study cannot
necessarily be extrapolated to different climates where the weather is different. Seventh,
our population-wide analysis assumed that all participants have the same weather–pain
relationship. Different diseases may have different sensitivities to pain and, even within
disease, participants may be affected differently. Our decision to use the whole chronic-pain
population in our primary analysis means the overall associations with weather variables
may be combinations of strong, weak and absent causal effects, thereby underestimating
the most important associations. Notable differences were not seen after stratification by
pain condition, although the power to detect any differences was reduced because of
smaller sample sizes. Lastly, the inclusion of repeated events per person required us to
consider within-subject dependence which, if not accounted for, would lead to bias.[21] Our
outcome was based on changes in pain (a two or more category increase), which meant
events rarely occurred on consecutive days, thereby ensuring a time gap between recurrent
events and the avoidance of bias.