Editor’s note: Ercolie Bossema is a researcher at Utrecht University in the Netherlands. She and her colleagues conducted a study on the effects of weather on fibromyalgia symptoms, which was recently published in the journal Arthritis Care and Research.
After hearing that many of our readers objected to some aspects and conclusions of the study, Ms. Bossema kindly agreed to address them in this column.
We are sorry that our article upset some of your readers. We are glad to address some of the issues raised by them.
First of all, we want to emphasize that it was not our intention to challenge the beliefs of people. We wanted to examine in a scientific way a phenomenon that has been experienced so often by people with fibromyalgia.
Second, we want to stress that our findings pertain to groups of individuals. Overall, our analyses of daily symptoms reports of more than 300 people with fibromyalgia showed more evidence against than in support of an influence of specific weather conditions on daily symptoms of pain and fatigue. However, our findings do not rule out that a relation between the weather and symptoms hold for a specific individual.
Third, people with fibromyalgia are often confronted with invalidation, which can be defined as responses of others that are denying, lecturing, not supporting, and not acknowledging the condition of the patient. With our findings we might give the impression that we wanted to disprove the existence of a real relation between symptoms and external conditions. However, that’s not true.
We believe that fibromyalgia is a sensitivity syndrome and that pain and fatigue in fibromyalgia are triggered more easily by all kinds of stimuli than in people not having fibromyalgia. We wanted to verify in an objective way whether this also holds for the weather. Surely, we did not want to plague people.
Fourth, one reader comments that this study is “going to push back all the hard work we have done in trying to get more research for fibromyalgia.”Another suggests that our study is “flawed.” And still another suggests that we might have done the study “with an agenda of non-belief.”
This is surely not true. We think that research in fibromyalgia is very important. The research group of Utrecht University does a lot of research in fibromyalgia and all research is done in collaboration with patient representatives. We are independent researchers that do the research in a conscientious way. Rather than seeking controversy, people with fibromyalgia and researchers should join to understand fibromyalgia and to find improved treatment.
There were several comments with respect to the design of the study. We want to briefly summarize characteristics of the study:
1. A total number of 333 female patients were included; all had a rheumatologist certified diagnosis of fibromyalgia according to established criteria. This is not a small sample size. It is unlikely that the findings would have been otherwise if more patients would have been included.
2. The influence of the following weather variables was examined: air temperature, sunshine duration, precipitation, atmospheric pressure, and relative humidity.
In general, the weather circumstances were not extreme. However, weather conditions change a lot in the Netherlands and also in this study weather conditions varied a lot for most patients during the four weeks of the study. Thus, our study results do not hold for very extreme weather conditions, but for common variations in the weather.
3. Patients participated in three seasons: autumn, summer and winter, but not spring. Thus, measurements were taken at different times for different patients.
Overall, we do not want to challenge the beliefs of people with fibromyalgia or refute the truth of their own experiences. Sometimes patients tell us that a specific diet improves their symptoms. They try to convince us that we should recommend this diet to other people with fibromyalgia.
However, we cannot support such a recommendation because what is beneficial for the one may not be beneficial for another. Scientific research is needed to examine whether a recommendation can be given to a majority people or a specific subgroup.
Enhanced sensitivity to pain and fatigue is core to fibromyalgia. However, whereas in the one patient the one situation may trigger or aggravate symptoms (the weather, emotions, a diet, strenuous exercise), in another patient quite another situation may be more relevant.
That our study indicates that relations between the weather and symptoms are not very common in fibromyalgia, does not rule out the existence of such a relation in a specific person with fibromyalgia.