Home Medicine Whether the weather influences pain: High prevalence of chronic pain in Iceland and Norway: Common genes? Or lack of sunshine and vitamin D?
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Whether the weather influences pain: High prevalence of chronic pain in Iceland and Norway: Common genes? Or lack of sunshine and vitamin D?

  • Harald Breivik
Published/Copyright: July 1, 2010
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 1 Issue 3

In this issue of the Scandinavian Journal of Pain Gunnarsdottir et al. [1] report the findings of a study on the prevalence and impact of chronic pain in Iceland. The most striking finding is that the prevalence is high, close to 31% and exactly as high as in Norway [2]. The prevalence in Iceland and Norway are higher than in most Southern-European countries (in Spain only 12% [2]), but also higher than in the other Nordic countries: 20% in Denmark [3], 18% in Sweden [2] and 19% in Finland [2]. Is this just an accidental finding caused by flaws in the surveyed samples in Norway and Iceland? Whereas one study found a slightly lower prevalence in Norway, i.e. 25% [4], two other major health surveys in Norway confirmed a prevalence of chronic pain of moderate-to-severe intensity to be close to 30% [5,6].

1 Pain sensitivity and response to painful stimuli are determined by genes and environment: Iceland and Norway have genes in common and similar environment

Norbury et al. [7] and Nielsen et al. [8] documented that the sensitivity to painful stimuli and pain tolerability are in a significant part determined by our genes. Norwegians and Icelanders may have many genes in common: About 1000 years ago the first inhabitants of Iceland came from the western parts of Norway, and even today the population of Iceland is genetically quite homogeneous. Although Irish monks came to Iceland and taught the Icelanders how to read and write on calfskin (vellum), these monks most likely did not leave much genetic material on Iceland. But they were one important reason that we do have written accounts of the history of the Iceland and the Norwegian kings from around 1000 AD onward!

Therefore, it may not be a too far fetched hypothesis that there are some genetic similarities between Norwegians and Icelanders in their genetically determined pain sensitivity and pain tolerance.

2 Are lack of sunshine (and vitamin D) more likely reasons for the high prevalence of chronic pain in Iceland and Norway?

Norway stretches from 60° northern latitude (Oslo, in the south of Norway, has the same latitude as Anchorage, Alaska) to 75° northern latitude, which is as far north as the arctic part of Canada (Arctic Bay on Buffin Island is about 73° northern latitude). Iceland lies between 64° and 67° northern latitude, about the same as Alaska and southern part of Greenland. In addition the Norwegian populations live in deep fjords and valleys surrounded by mountains that keep the sun away from people even during much of spring and autumn.

This means we have little, or no sunshine in large parts of the year, and even though most people are fair-skinned and a majority of our populations grow up having to drink cod-liver oil for breakfast, we still are deficient in vitamin D, except during the brief and intense summers. In spite of cod-liver oil for breakfast, we suffer from consequences of low vitamin D, such as having the world record of fractured collum femoris, and other problems caused by osteoporosis.

The low amount of sunshine in our part of the world is not enough, even for those who have the typically fair skin, to produce sufficient amounts of vitamin D. With the rapidly growing part of the Norwegian population who are immigrants with dark skin, we have rediscovered diseases such as rickets (rachitis), due to extreme vitamin D deficiency [9]. There are striking case stories of adult persons moving to the Nordic countries from Pakistan or India, developing severe generalized pain, and being cured completely by cod-liver oil!

Norwegian patients with severe pain from osteoarthritis, rheumatoid arthritis, and other chronic painful conditions, are able to enjoy extended stays in the Canary Islands or other sunny places during wintertime (courtesy our generous health care system). While in the sunny south, their pain disappears more or less. But after a few weeks back home in Norway, they revert to their customary burdensome pain conditions.

After 30 min sunbathing during the Nordic summertime an adult person will produce as much vitamin D as there is in 250 ml codliver oil! But the very effective sunscreen ointments that protect against sunburn and melanoma, also reduce production of vitamin D in the skin [10,11].

It was noted by cancer researchers at the Norwegian Cancer Hospital that patients who started their cancer treatment during the end of summer or early fall (with high vitamin D in their body) have better prognosis than those who start their cancer treatment during the winter or spring months [10]. This is only one of a number of beneficial effects of vitamin D:

3 Blessings of vitamin D

Vitamin D improves prognosis from cancer treatment [10], reduces risk of developing cancer in internal organs [10,11,12], reduces risk of thromboembolic events [13], reduces risk of developing diabetes mellitus [11], multiple sclerosis [11], osteoporosis and fractures [11], cardiovascular diseases [11], Crohn’s disease [11], rheumatoid arthritis [11], and having severe influenza-infection [11]. Vitamin D speeds up recovery from depression [15], it slows the ageing-process (maybe) [14], and reduces all-causes mortality [16]. Vitamin D reduces chronic widespread pain [17].

It is noteworthy and of significance to this discussion that it has repeatedly been documented that the risk of chronic noncancer pain is significantly higher in persons with little education and in lower socioeconomic strata in the Nordic countries [3,6]. This may be related to lack of knowledge and ability of having food-sources of vitamin D (fat fish, etc.).

4 Is it moderate-to-severe musculoskeletal pain that flares up when the sun disappears?

Even in North West England the prevalence of “any pain” and of “wide spread pain” is higher during the seasons with less sunshine, and markedly less in summertime [17].

Wintertime with cold and snow also depresses mental mood and discourages physical activities, both of which also aggravate pain, especially musculoskeletal pain conditions [17].

It is noteworthy that, in the European Survey of chronic pain, carried out during winter and spring of 2003, the prevalence of very severe chronic pain (7–10 on a 10 point pain intensity scale) was about the same in Norway and in Spain, i.e. it is the chronic, mostly musculoskeletal, pain of moderate-to-severe intensity, not the most excruciating pain, that differs between Spain and Norway – and Iceland. It would be too much to hope for that any type of very severe pain could be relieved by sunshine or solarium.

5 Conclusions

Epidemiological studies are consistent in documenting a high prevalence of significant pain in Norway, and the high quality study published in this issue of the Scandinavian Journal of Pain [1] confirms that the prevalence of significant chronic pain and its many deleterious consequences to quality of life, physical and social functions are at least as high in Iceland, as in Norway [2,6]. It is not unlikely that the short summers in our countries close to the North Pole do not secure sunshine induced vitamin D production sufficient for the remaining, dark, part of the year. Vitamin D deficiency has a number of unhealthy consequences, and increased risk of chronic pain is likely to be one important one. Whether a sunny weather influences pain is beyond doubt [17].

It is time to do more proper studies, but it is not too early to start prescribing solarium and a week or two in the sunny south during wintertime for patients with chronic pain in the northernmost parts of the Nordic countries.

DOI of refers to article: 10.1016/j.sjpain.2010.05.028.

References

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[17] Macfarlane TV, McBeth J, Jones GT, Nicholl B, Macfarlane GJ. Whether the weather influences pain? Results from the EpiFunD study in North West England. Rheumatology 2010, doi:10.1093/rheumatology/keq099 [epub before print].Search in Google Scholar
Published Online: 2010-07-01
Published in Print: 2010-07-01

© 2010 Scandinavian Association for the Study of Pain

Articles in the same Issue

  1. Editorial comment
  2. Functional brain imaging of acute postoperative pain
  3. Clinical pain research
  4. Brain activation due to postoperative pain from the right hand measured with regional cerebral blood flow using positron emission tomography
  5. Editorial comment
  6. Long-term low-dose transdermal buprenorphine therapy for chronic noncancer pain
  7. Original experimental
  8. A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naïve to potent opioids
  9. Editorial comment
  10. Repeated nociceptive stimulation for detecting drug effects
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  13. Editorial comment
  14. Whether the weather influences pain: High prevalence of chronic pain in Iceland and Norway: Common genes? Or lack of sunshine and vitamin D?
  15. Observational studies
  16. A population based study of the prevalence of pain in Iceland
  17. Editorial comment
  18. Swedish nurses are prone to chronic shoulder and back pain because of miserable working conditions and poor leadership?
  19. Observational studies
  20. Predicting of pain, disability, and sick leave regarding a non-clinical sample among Swedish nurses
  21. Abstracts
  22. Trigeminal neuralgia or odontogenic pain
  23. Abstracts
  24. What’s wrong with animal models of pain?
  25. Abstracts
  26. Immunotherapy for neuroblastoma elicits a complement dependent whole body allodynia
  27. Abstracts
  28. Pain mechanisms in animal models of rheumatoid arthritis
  29. Abstracts
  30. Translating basic research to pharmacological treatment of neuropathic pain
  31. Abstracts
  32. Free Poster Presentations: Forearm heat pain does not inhibit electrically induced tibialis anterior muscle pain
  33. Abstracts
  34. Offset analgesia evoked by non-contact thermal stimulator
  35. Abstracts
  36. Inhibition of FAAH reverses spinal LTP
  37. Abstracts
  38. Hyperexcitable C-nociceptors in human paroxysmal pain
  39. Abstracts
  40. Pain sensitivity and experimentally induced sensitization in red haired women
  41. Abstracts
  42. How are opioids used in Norway? Persistent use, utilization of depot formulation and age profile in non-palliation patients
  43. Abstracts
  44. To which extent does incident and persistent use of weak opioids predict problematic opioid use?
  45. Abstracts
  46. Is transdermal buprenorphine for chronic non-malignant pain used long term without co-medication with other potentially addictive drugs?
  47. Abstracts
  48. Prostaglandin E2 production in synovial tissue and acute postoperative pain after knee arthroscopy
  49. Abstracts
  50. Girl presenting with oesophageal spasm pain after fundoplication
  51. Abstracts
  52. Epidemiology of persistent postoperative pain: Association of persistent pain and sensory abnormalities
  53. Abstracts
  54. Cost–benefit of a 13-week multidiciplinary rehabilitation course for chronic non-malignant pain patients
  55. Abstracts
  56. A novel and effective treatment modality for medically unexplained pain
  57. Abstracts
  58. Somatocognitive therapy in the management of chronic gynaecological pain. A review of current approach and historical background
  59. Abstract
  60. The Manual Intervention Trial (MINT)—The effect of various combinations of naprapathic manual therapy. The study protocol of a randomized controlled trial
  61. Abstracts
  62. The experience of chronic pain, loss and grief
  63. Abstracts
  64. Effect of buprenorphine and fentanyl in experimental induced superficial, deep and hyperalgesic pain
  65. Abstract
  66. Pretreatment with opioids enhances afferent induced long-term potentiation in the rat dorsal horn
  67. Abstracts
  68. Pigs in pain—Porcine behavioural responses towards mechanical nociceptive stimulation directed at the hind legs
  69. Abstracts
  70. A human experimental bone pain model
https://doi.org/10.1016/j.sjpain.2010.05.030

Articles in the same Issue

  1. Editorial comment
  2. Functional brain imaging of acute postoperative pain
  3. Clinical pain research
  4. Brain activation due to postoperative pain from the right hand measured with regional cerebral blood flow using positron emission tomography
  5. Editorial comment
  6. Long-term low-dose transdermal buprenorphine therapy for chronic noncancer pain
  7. Original experimental
  8. A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naïve to potent opioids
  9. Editorial comment
  10. Repeated nociceptive stimulation for detecting drug effects
  11. Original experimental
  12. The effects of gabapentin in human experimental pain models
  13. Editorial comment
  14. Whether the weather influences pain: High prevalence of chronic pain in Iceland and Norway: Common genes? Or lack of sunshine and vitamin D?
  15. Observational studies
  16. A population based study of the prevalence of pain in Iceland
  17. Editorial comment
  18. Swedish nurses are prone to chronic shoulder and back pain because of miserable working conditions and poor leadership?
  19. Observational studies
  20. Predicting of pain, disability, and sick leave regarding a non-clinical sample among Swedish nurses
  21. Abstracts
  22. Trigeminal neuralgia or odontogenic pain
  23. Abstracts
  24. What’s wrong with animal models of pain?
  25. Abstracts
  26. Immunotherapy for neuroblastoma elicits a complement dependent whole body allodynia
  27. Abstracts
  28. Pain mechanisms in animal models of rheumatoid arthritis
  29. Abstracts
  30. Translating basic research to pharmacological treatment of neuropathic pain
  31. Abstracts
  32. Free Poster Presentations: Forearm heat pain does not inhibit electrically induced tibialis anterior muscle pain
  33. Abstracts
  34. Offset analgesia evoked by non-contact thermal stimulator
  35. Abstracts
  36. Inhibition of FAAH reverses spinal LTP
  37. Abstracts
  38. Hyperexcitable C-nociceptors in human paroxysmal pain
  39. Abstracts
  40. Pain sensitivity and experimentally induced sensitization in red haired women
  41. Abstracts
  42. How are opioids used in Norway? Persistent use, utilization of depot formulation and age profile in non-palliation patients
  43. Abstracts
  44. To which extent does incident and persistent use of weak opioids predict problematic opioid use?
  45. Abstracts
  46. Is transdermal buprenorphine for chronic non-malignant pain used long term without co-medication with other potentially addictive drugs?
  47. Abstracts
  48. Prostaglandin E2 production in synovial tissue and acute postoperative pain after knee arthroscopy
  49. Abstracts
  50. Girl presenting with oesophageal spasm pain after fundoplication
  51. Abstracts
  52. Epidemiology of persistent postoperative pain: Association of persistent pain and sensory abnormalities
  53. Abstracts
  54. Cost–benefit of a 13-week multidiciplinary rehabilitation course for chronic non-malignant pain patients
  55. Abstracts
  56. A novel and effective treatment modality for medically unexplained pain
  57. Abstracts
  58. Somatocognitive therapy in the management of chronic gynaecological pain. A review of current approach and historical background
  59. Abstract
  60. The Manual Intervention Trial (MINT)—The effect of various combinations of naprapathic manual therapy. The study protocol of a randomized controlled trial
  61. Abstracts
  62. The experience of chronic pain, loss and grief
  63. Abstracts
  64. Effect of buprenorphine and fentanyl in experimental induced superficial, deep and hyperalgesic pain
  65. Abstract
  66. Pretreatment with opioids enhances afferent induced long-term potentiation in the rat dorsal horn
  67. Abstracts
  68. Pigs in pain—Porcine behavioural responses towards mechanical nociceptive stimulation directed at the hind legs
  69. Abstracts
  70. A human experimental bone pain model
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