When a heat wave arrives, the public health advice follows a familiar script: drink water, watch for heat stroke, check on people with heart or lung conditions. That list saves lives. But it leaves out something that shapes daily life for millions of older Americans – chronic pain.

In a new study, public health professor Kai Zhang and I followed over 35,000 adults over age 50 across two decades, matching each person and their reports of chronic pain to the temperature history of their neighborhood.

We wanted to know whether living with extreme heat or cold – not one bad week, but months or years – changes whether pain interferes with people’s lives.

The results suggest that chronic pain deserves a place in how the country prepares people for extreme weather. They also show that rural residents may be the least protected.

What high-impact pain means

Researchers use the term high-impact chronic pain for pain lasting at least three months that limits what a person can do: work, socializing and self-care. It is not occasional aching. It is pain that affects your decisions.

For adults over 50, that matters enormously. Pain that makes it hard to stand, carry groceries or sleep through the night is a leading reason people lose the ability to live on their own.

Temperature affects the body in different ways that can lead to pain:

Cold appears to increase pain sensitivity and stiffen joints, which is why people with arthritis often brace for winter.

Heat affects the body through dehydration, broken sleep and the way it quietly shrinks the range of things a person is willing to do in a day. On hot days, for example, people may walk........

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