Poster Number-76 - The Heat is On: When Hot Weather Hurts

The Heat is On: When Hot Weather Hurts

Purpose: Both meteorologists and the Farmer’s Almanac predict an unusually hot summer in 2022. From 2018 to 2020, the Centers for Disease Control and Prevention (CDC) reported 3,066 heat-related deaths. According to the CDC, the most affected age group for heat mortality are those between the ages of 55 to 64.  The body maintains a core temperature of around 104⁰ Fahrenheit; perspiration combined with vascular efforts to migrate overheated blood to the periphery is the body’s compensatory mechanism to cool down. Humid weather impairs this adaptive function and has given rise to the “heat index,” a combination metric that provides a “feels like” temperature using heat plus humidity. When the body becomes overheated, cellular damage can occur and lead to a potentially fatal physiologic cascade to organ failure. Besides heat-related illnesses such as heat exhaustion and heat stroke, heat can have adverse consequences on those with pre-existing chronic conditions. The purpose of this poster is to describe how heat affects us all and how heat affects people with chronic pain in particular.

Methods: This is a narrative review based on authoritative websites and a literature search using the Medline databases of the National Institutes of Medicine. There is a paucity of research on the impact of heat on pre-existing condition.

Results:

Heat-related conditions can occur in people of all ages with all different degrees of heath. These include sunburn, heat rash, heat cramps, heat exhaustion, and the life-threatening emergency of heat stroke. People who work or exercise outdoors in the heat for prolonged periods of time are particularly vulnerable.

People with cardiovascular deficits may be at elevated risk for heat-related problems because part of the body’s compensatory cooling system involves moving blood from the core to the periphery for cooling. Vascular compromise can make this difficult.

Not often reported is the role of medication in heat-related illness. Drugs that help regulate the balance of salt and water in the body, such as hypertension medications, can adversely affect how the body responds to heat.

Dehydration can cause painful symptoms, particularly headache and muscle aches. Drinking alcohol or caffeine can have dehydrating effects.

Bright sunlight is a frequently reported trigger for migraine headaches. Even those who are not migraineurs may experience headache with prolonged exposure to the heat and bright light.


Heat can also cause muscle spasms which can exacerbate the pain experienced by those with chronic back pain or other chronic musculoskeletal conditions. Heat may exacerbate inflammation, which can intensify the chronic pain associated with many diseases such as chronic pelvic pain, gout, or pain associated with an infection.

Finally, high temperatures can interfere with restorative sleep. For chronic pain patients already struggling to sleep, this can intensify their pain and heighten their discomfort. For those with mood disorders, frequently comorbid with chronic pain, the uncomfortable feelings of being too hot can intensity irritability and distress.

Many chronic pain patients depend on exercise to manage their pain, at least in part. High temperatures can limit the activities of those who walk, cycle, or exercise outside and may promote sedentariness. For many chronic pain patients, this will over time exacerbate pain. Water exercises can be helpful in the hot summer months, particularly for those with joint pain.

Topical analgesic products can be combined with sunscreen for outdoor use. The best protections against heat-related pain are obvious: stay in the shade as much as possible, cool down (or go inside a cool place) when you feel overheated, drink lots of water, and wear loose light-colored clothing.
Note that heat exhaustion is characterized by profuse perspiration, clammy skin, and dizziness; sometimes people also get nauseous and have muscle cramps. Call for emergency help at once if a person has heat stroke, characterized by hot, dry skin, a high body temperature, and symptoms of nausea, headache, confusion, and disorientation. Heat stroke can be fatal.



Conclusion: The summer of 2022 will be abnormally hot and this means there is a greater-than-average risk for heat-related illnesses and even mortality. For people with pre-existing painful conditions or pre-existing disorders such as heart disease, heat can pose special problems. Bright sunlight and high temperatures can trigger headaches; hot weather and a high heat index can cause muscle cramps. Heat may also exacerbate inflammatory conditions, interfere with good sleep, and reduce the ability to exercise outdoors. As much as possible, everyone should avoid extreme heat, keep well hydrated, and stay in the shade when possible.

References: N/A