Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole, and joining me today to highlight cold weather and body aches is Dr. Philip Petrou. He's an assistant professor of clinical anesthesiology at Weill Cornell Medical College, Cornell University. Dr. Petrou, it's a pleasure to have you join us again, and can you briefly explain why some people experience increased aches and pains during cold weather. What physiological changes occur in our bodies during cold weather that could contribute? You and I both live in cold weather climates, so we do get winter. And we notice these things, right? I noticed things ache a little bit more than they used to in the winter time.

Philip Petrou, MD: Right. Agreed, Melanie. And first, thank you so much for having me on this podcast today. So, you know, especially with the winter months coming and, you know, with the coldness settling in, there's not a clear cut explanation for why we get these joint pains in the cold weather,. But some things that contribute is, one, just in general, when it's cold out, you know, blood vessels constrict. There's not as much blood supply getting to the joints, to the nerve endings. And then also, with the cold weather comes the change in atmospheric pressure or the change in the barometer pressure. This can cause an expansion of the joints and increasing the thickness of the synovial fluid in our joints that may explain some of the stiffness and pain that we feel in these winter months.

Melanie Cole, MS: So, we think about this as something that affects older people, people with arthritis, that sort of thing. I mean, with arthritis, sometimes cold temperatures could help by reducing some of that inflammation, but it seems like people with arthritis have more pain in the winter, yeah?

Philip Petrou, MD: You know, with arthritis, we think of two general categories, the osteoarthritis and the rheumatoid arthritis. You know, with the osteoarthritis being more of that kind of wear and tear that comes with aging. And in that case, again, the possible idea of contributing factors from the cold weather is that there's more stiffness from that synovial fluid not being thickened, as well as in general, just with the drop in the barometric pressure, you have the expansion of the joint areas that cause that pain.

Things to consider, you know, for rheumatoid arthritis is that it's more of an inflammatory arthritis. And in that case, again, with the cold weather, the decrease or the vasoconstriction in the blood vessels and the decreased blood flow can possibly be contributing.

Melanie Cole, MS: So, can you give us some tips for people that have chronic pain that notice that it's exacerbated in the wintertime? Are there things that you would like them to do? Exercises that can help with some of those body aches? We're going to talk about, you know, maybe medicational interventions, but just sort of lifestyle things, something we can do.

Philip Petrou, MD: I think, first and foremost, dress warmly in layers is very helpful. Wearing those zipper jackets, things that can come off, those thin t-shirts that can come off, come on as needed so that you can stay warm depending on, you know, if you're transitioning from the inside to outside. Also remembering wearing the hats, wearing gloves, all those clothing areas where we sometimes forget, the body areas can lose heat very quickly.

Other things, you know, it's important to stay active and that's the one of benefits of wearing the layers is that, as you're active, you can take off the layers as needed or add layers as you're kind of slowing down. But, you know, trying to get out in the morning, trying to walk outside, or even indoor activity in terms of walking on the treadmill, things like if you're able to find a heated swimming pool. I know difficulty is given in New York. And then lastly, I think just finding other kind of heat pads can be very helpful.

Melanie Cole, MS: Oh yeah, heating pads, that's a good one. That helps a lot to help loosen up those muscles, especially in the winter. Now, from a medical perspective, Dr. Petrou, medications, you're an anesthesiologist, so you deal in pain management every day. What do you recommend as far as managing that pain that's exacerbated by cold weather? Is it Motrin, Tylenol, something by prescription? What do you recommend?

Philip Petrou, MD: Excellent question. I think, first and foremost, I always encourage patients to speak with their physician directly. Obviously, it's important to get tailored advice that's what's the benefit of developing that personal relationship with a healthcare provider. But that being said, you know, especially with over-the-counter medications that are available to patients, you know, we talk to patients assuming they're healthy, assuming they don't have any significant medical problems. We encourage Tylenol over-the-counter. We also encourage Motrin over-the-counter, or other like NSAIDs, like ibuprofen.

Melanie Cole, MS: Do you have a preference between Tylenol and ibuprofen?

Philip Petrou, MD: So, you know, when I counsel patients, again, it really depends on what their other medical comorbidities are. It's hard to give a general response to patients without taking into consideration their medical problems as well as their past experiences with different medications. Other things to think about or to consider are the topical agents, such as lidocaine patches or Voltaren gel, because they're not systemically absorbed, often can have a safer profile compared to oral medications.

Melanie Cole, MS: That's so interesting. I always think of things like Motrin as being an anti-inflammatory and pain reliever, whereas Tylenol just being a pain reliever. Does that matter when we're thinking of arthritis and things that get really slow and viscous and tightened up in the winter.

Philip Petrou, MD: Excellent question. I think the reality is that both Tylenol and the NSAIDs, or the non-steroidal anti-inflammatory drugs, have different mechanism of actions. They don't have overlap and they can work in conjunction with each other. But you are correct, typically, when we think about the arthritis as being a pro-inflammatory state, first line often patients will be recommended NSAIDs, again, the non-steroidal anti-inflammatory drugs. But that being said, again, everything has to be taken in moderation and really patients should be seeing a healthcare provider to develop a tailored treatment plan that can be used long-term.

Melanie Cole, MS: That's great advice. Now, what about preventing injuries in the cold? You mentioned clothing to keep us warm and moving around or treadmill or pool exercises, getting out and about. But what about injuries? So, not only is our joints and things hurting a little bit more, so we are a little less steady on our feet. But there might be ice on the ground, there might be slippery conditions. And so, there's a whole host of things that can go wrong when our bodies don't respond the way that they used to.

Philip Petrou, MD: I think that's why it's definitely important to have footwear that has a strong grip on the ground so that falls are reduced. I think also, one thing, to keep in mind is that with the cold weather is that, you know, not staying too inactive, but taking precautions. And one way to do that is to be active indoors, so doing physical therapy indoors, working with a personal trainer. Basically still staying active, but not necessarily in the hardships of the wintry landscape.

Melanie Cole, MS: And what about diet and supplements. Dr. Petrou, because we hear a lot about chondroitin and all these things that can help our joints and our achy joints. Do any of those have merit? Is there any diet nutritional things you'd like to mention?

Philip Petrou, MD: It's an excellent question that patients often present to pain clinic for. I say the official answer is that these are not FDA approved in terms of the supplements for pain relief, and a strong reason behind is that it's very hard to do double blind, randomized controlled clinical trials that demonstrate efficacy of these supplements. In terms of, you know, what has been shown, there's at least, you know, in Europe, alpha-lipoic acid is used for diabetic peripheral neuropathy that can be exacerbated in cold weather, given, you know, again, that conversation about the vasoconstriction of the blood vessels affecting the nerves. That is something patients, at least, I bring up with them if they're strongly interested. But again, you know, I just remind them that the things that we know will be helpful are staying active, staying warm, dressing warmly, using any heat therapy, compared to spending their money on supplements.

Melanie Cole, MS: This is great information and important for us to hear. So Dr. Petrou, wrap it up for us. What would you like listeners to know? You deal in pain management every day in a pain clinic and people come to you with all sorts of aches and pains. But in the wintertime, as we've said, and in the cold weather months, it just seems to be a little bit more or maybe a little bit slower movement. I mean, we get our aches and pains in the summer, but it feels somehow different. What would you like everybody to take away from this episode?

Philip Petrou, MD: My summary statement would be, you know, first and foremost, dress warmly; second, stay active, do physical therapy, walk around indoors; thirdly, I think, you know, apply heat therapy as needed if it's helpful; and then, lastly, I just remind patients that, you know, some of the aches and pains that they're having are possibly they're just chronic pain that's not necessarily cold related. And in that case, they should come see us for possible interventions. You know, for arthritis, we counsel patients on radiofrequency ablation or even nerve stimulation to help those conditions. So, something just to distinguish between is this a acute issue precipitated by the cold weather or is this just my chronic issue that's gotten a little worse in the weather time and now it's time to see an interventionalist to discuss further management.

Melanie Cole, MS: Those are great points, and thank you so much, Dr. Petrou, for joining us today and sharing your incredible expertise. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify, Pandora, and Google Podcasts. For more health tips, please visit weillcornell.org and search podcasts. And parents, don't forget to check out our kids healthcast. I'm Melanie Cole. Thanks so much for joining us today.

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