Long-term exposure to extreme temperature and high-impact chronic pain among middle-aged and older U.S. adults.

Existing studies have documented associations between daily temperature fluctuations and pain, but less is known about the sustained effects of temperature patterns over longer periods. This study is among the first to examine how prolonged exposure to extreme cold and heat over months and years shapes high-impact chronic pain (HICP) outcomes, including HICP reporting, two-year HICP incidence, and two-year HICP recovery. We linked Health and Retirement Study data (1998-2022) with census tract-level temperature data and applied hierarchical logistic models. Results indicate that high long-term (12-month) exposure to extreme cold is associated with a 4% increase in the odds of reporting HICP (95% CI: 0%-9%, p = 0.045). Intermediate-term (3-month) exposure to extreme cold and both intermediate- and long-term exposure to extreme heat are not significantly associated with HICP reporting in the overall population. Interaction analyses reveal that individuals with higher education and those living in cold or very cold climate zones are more likely to report HICP under sustained extreme cold. In contrast, people in the lowest wealth quartile and rural residents experience higher HICP incidence under cumulative exposure to extreme heat, whereas extreme heat exposure is associated with lower HICP incidence and higher recovery among individuals in the wealthiest groups. These findings provide novel evidence on environmental determinants of chronic pain and underscore the importance of climate-adaptive strategies for pain prevention and management.