People experiencing chronic lower back pain said that being in or around nature can provide them with a degree of escapism that helps them better manage their physical discomfort, a groundbreaking study has found.

The research, to be published in the August issue of The Journal of Pain, is the first of its kind to ask people experiencing chronic lower back pain – in some cases for almost 40 years – about the role nature plays in the coping strategies they use to help manage their condition.

The article’s first author is Alexander Smith, a PhD researcher who is based at the universities of Plymouth and Exeter. His three fellow authors are either based at Plymouth or both universities. They found that the 10 people who took part in the study who are able to get out in nature said it enabled them to connect with others on a social level, whereas they might otherwise spend most of their time indoors and isolated.

The participants, who had experienced chronic lower back pain for between five and 38 years, were aged from 38 to 66 years. They said nature provided them with a degree of distraction from their pain and a sense of escapism from their daily lives, and they enjoyed the opportunity to exercise in pleasant surroundings, preferring it to gyms or similar settings.

In addition, natural features such as fresh air and the sound and visual presence of water, the interviewees said, helped give them a feeling of tranquillity that relieved the stresses and anxieties created by their pain levels.

Accessibility a key issue

However, they did have concerns about the accessibility of some spaces, with factors such as unsteady or uneven terrain and a lack of seating having the potential to reduce their enjoyment of – and making them less inclined to visit – certain places.

Based on their findings, the researchers recommend that people with chronic lower back pain – and the clinicians treating them – should focus on the role that nature can play in their health and wellbeing, and suggest that natural spaces could be adapted to incorporate more accessible design features.

‘In general, enhancing and raising the accessibility of nature for groups such as the chronic pain community could be an invaluable tool in enabling greater self-management, but further research needs to be conducted into its both its analgesic efficacy and appropriate avenues to increase accessibility’ [Alexander Smith et al]

They are also working with people with varying forms of chronic pain to develop and test virtual reality innovations that may enable them to experience the benefits of being in nature on occasions where they can’t physically access them.

Study could ‘open door’ to further studies

Mr Smith said: ‘Lower back pain, like many other forms of physical discomfort, can be debilitating, isolating and exhausting. But amid a push for novel and more holistic therapies to treat chronic pain, nature has been suggested as a potential option. Our research showed that those able to get out into nature saw the benefits of doing so, both from a physical and a mental perspective.’

Mr Smith added: ‘Simple changes, such as better paths and seating, and technological innovations including virtual reality may help make those benefits accessible to everyone. But we hope our findings open the door to greater exploration of how that might be achieved.’

Sam Hughes, a senior lecturer in pain neuroscience at the who was the study’s senior author, noted: ‘This study addresses important questions about health equity and the significant physical barriers faced by people living with chronic pain in accessing natural spaces. Many individuals encounter substantial obstacles, including uneven terrain, limited seating, or difficulties leaving their homes, making it challenging for them to benefit from the restorative properties of nature.’

Potential role for ‘immersive technologies’

Dr Hughes added: ‘We think that future research could use immersive technologies, such as virtual reality, to help overcome these barriers which would enable individuals to experience the benefits of nature without needing to physically navigate inaccessible environments. This could significantly enhance inclusivity and accessibility in chronic pain management strategies in the future.’

To access the full version of the study – titled ‘Being away from everything’: Exploring the importance of access to nature for individuals living with chronic low back pain – see: 10.1016/j.jpain.2025.105440.

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