extreme heat and cold are silently worsening chronic pain for millions of older americans

A new study published by public health professor Kai Zhang and a colleague tracked over 35,000 adults over age 50 across two decades, matching each person's reports of chronic pain to the temperature history of their neighborhood. The research aimed to determine whether living with extreme heat or cold over months or years changes whether pain interferes with people's lives. The study found that sustained exposure to extreme temperatures significantly increases the likelihood of developing high-impact chronic pain.

The researchers tracked when each neighborhood hit temperatures that were extreme for that specific place, comparing every community against its own 10-year record rather than using a single national cutoff. This localized approach allowed them to see how months or years of exposure to extreme cold or heat temperatures in those communities affected their residents. The results showed that rural residents may be the least protected from these temperature-related pain effects. One likely reason is that people in rural areas may spend more time working outside, have older homes that are harder to cool, and have less access to cool places. Energy costs tend to take a larger share of income in rural areas, and rural hospitals have been closing across the country, leaving residents driving farther to reach healthcare.

Among the poorest older adults, sustained heat was associated with a higher chance of developing high-impact pain. Among the wealthiest, it was not, likely because of better access to air conditioning, healthcare, and the ability to stay out of the heat. Those who could get out of the heat were least likely to report feeling new chronic pain. The study also highlighted that agriculture has the oldest workforce in the country, with the average producer in decision-making roles on a farm now about 58 years old, and nearly 40% of farmland owned by farmers 65 or older.

Nearly every tool U.S. communities use to lower heat risk is designed for a city environment, including cooling centers, tree canopy programs, and urban heat island maps. State and county heat plans flag cardiac and respiratory patients but not people whose independence depends on managing pain. The researchers suggest that chronic pain deserves a place in how the country prepares people for extreme weather. With warning, people can plan ahead and get help, knowing chronic pain may worsen. The study implies that if someone has a parent or grandparent facing a heat wave, particularly in a rural area, they should ask not just about hydration but also whether their back or knees have been worse than usual.