Nature is the best medicine, they say, and that’s absolutely right. Being in nature can significantly improve health and well-being, even for individuals who have suffered from chronic lower back pain.
A new study reveals that spending time outdoors in nature can offer individuals with chronic lower back pain a sense of escapism, which helps them manage their discomfort more effectively.
A Disability Affecting Millions
Chronic low back pain (cLBP) is a highly prevalent condition globally and the primary reason behind ‘years lived with disability’ (YLD).
This refers to the pain experienced in the lower back. Besides pain, this condition can also include decreased movement of the lower back, stiffness in the back, and difficulty standing straight. When this pain persists for an extended period, it is referred to as chronic low back pain.
Low back pain (LBP) can result from a strain or injury to the muscles or tendons in the back. It could have been caused by a single event or due to many activities, like lifting the wrong way for a long time.
A herniated disk, the curvature of the spine like scoliosis, and medical problems such as rheumatoid arthritis, among other factors, could also be the cause of this pain.
The exact cause of the pain can often not even be found. In fact, non-specific low back pain is the most common (about 90%) presentation of LBP.
By making it hard to move, limiting work activities, and engagement with friends and family, chronic lower back pain significantly affects the quality of life as well as mental well-being.
It is also a very common problem with low back pain affecting 610 million people1 globally in 2020. This number is expected to rise to 843 million prevalent cases by 2050, primarily driven by population expansion and aging. The global age-standardized rate of YLDs at the time was 832 per 100,000.
The high prevalence means that this medical problem contributes to a significant economic burden on societies, and as such, it needs to be addressed.
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Holistic Chronic Back Pain Relief with Nature Exposure
Through the lens of biopsychosocial, the interconnectedness of biological, psychological, and social factors in health, symptoms of cLBP are multidimensional, with all these factors influencing one another and often causing comorbidities.
Treatment options, however, are generally poor, with many individuals lacking adequate pain relief.
When it comes to managing chronic lower back pain, the psychosocial route is usually considered effective in reducing distress, disability, and pain. Improving access to nature has also been suggested as a way to help reduce the global burden of pain.
The therapeutic use of nature has seen growing applications in healthcare via nature-based social prescribing. A growing interest in this is due to the effectiveness of nature in promoting well-being, reducing stress, restoring attention, and improving mental and physical health.
In regards to chronic pain, the growing interest in green therapy has been in the potential of utilizing natural environments as a source of analgesia, i.e., pain relief.
Research2 has shown that exposure to nature actually creates analgesic effects in cases of acute and experimental pain.
In fact, patients with chronic pain situated near nature in inner-city areas have exhibited a reduced relationship between pain intensity and pain-related rumination. Exposure to nature can help alleviate widespread pain symptoms.
Researchers have also observed positive associations between green space exposure and the activation of brain areas implicated in stress, rumination, and negative affect, which overlap with pain processing.
While studies have been conducted regarding the connection between nature and pain relief, there is currently a lack of research in understanding the importance of nature to the cLBP community and how access to nature could be a part of self-management strategies.
To help with exactly this, researchers from the University of Plymouth and the University of Exeter came together to explore the potential of using nature to help manage pain and cLBP.
The aim of the study was to understand the lived experience of patients dealing with chronic lower back pain, in some cases for almost 40 years, in the context of how nature or being in natural environments forms part of their existing self-management approaches.
It is actually the first study to seek a qualitative understanding of the extent to which accessing natural spaces is important in the self-management of chronic low back pain (cLBP).
“This study addresses important questions about health equity and the significant physical barriers faced by people living with chronic pain in accessing natural spaces.”
– Dr. Sam Hughes, a senior lecturer in Pain Neuroscience at the University of Exeter
How Nature Transforms Pain Into Presence
The pioneering study, published in The Journal of Pain3, asked people having chronic lower back pain about the role nature plays in any coping strategies employed to deal with their condition.
Conducted by experts in pain management and environmental psychology from the University of Plymouth and Exeter, the study interviewed 10 people who had experienced cLBP for 5 to 38 years.
What the researchers found was that being out in nature enabled people to connect with others. This time spent socially engaging with others is otherwise spent by them indoors and isolated.
Those who were able to get out in nature and connect socially with others reported that the experience provided them with a degree of distraction from their pain. It not only gave them a sense of escapism from their daily lives, but they also enjoyed the opportunity to exercise in pleasant surroundings. People preferred nature to gyms or similar settings.
The interviewees told researchers that fresh air, the sound of water, and its visual presence, among other natural features, helped them experience a feeling of tranquility that alleviated their stress and anxiety levels, which were created by their pain.
According to lead author Alexander Smith, a PhD researcher at the School of Psychology, Faculty of Health, University of Plymouth, UK:
“Lower back pain, like many other forms of physical discomfort, can be debilitating, isolating, and exhausting.”
Amidst the ongoing push for new and holistic therapies for treating chronic pain, nature offers a potential option. This research shows that those who can get out into nature experience the benefits of doing so, from both physical and mental perspectives.
The problem, however, is accessibility. Study participants expressed concerns about their ability to access certain spaces. Factors such as uneven or unsteady terrain and a lack of seating can potentially reduce their enjoyment of certain places, making them less inclined to visit.
Based on the findings, the researchers recommend that both individuals with chronic lower back pain and the clinicians treating them give greater consideration to nature and its role in their health and well-being. They also suggest that natural spaces can be adapted to include design features that are more accessible.
“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.”
– Smith
The Theory Behind Relief: Attention Restoration & Stress Reduction
Overall, across ten semi-structured interviews with patients with cLBP, the researchers developed two themes with four subthemes from a reflexive Thematic Analysis.
Theme One described the necessity of accessing nature as a coping mechanism and its therapeutic benefits for people with regard to their pain. Theme Two described how, despite wanting and needing to access nature spaces, people were limited in their accessibility, which in turn, limited nature’s effectiveness as a coping strategy.
Together, the themes show that accessing and spending time in nature could offer an effective coping strategy but accessibility is limited for the cLBP community, which undermines its potential efficacy.
When it comes to the importance of nature, it offers patients distraction from focusing on their pain, and it enables a deeper connection to the world, others, and themselves.
“It is believed that pain requires attentional engagement,” noted the study, hence, an “immersive, engrossing, and pleasant distraction from that pain may aid removal of the salience of the pain, or divert attention away from the pain, making it less prominent in cognition.”
While enough to gently capture one’s attention enough for distraction, the pleasant stimuli in nature don’t consume the mind completely, thus still allowing for ‘mental housekeeping.’
The capacity of nature as a mechanism for restoring attention, cognition, and mental well-being is described through the Attention Restoration Theory (ART) and the Stress Reduction Theory (SRT).
Previous studies have observed a reduction in physiological measures correlated with stress and pain when spending time in nature, such as heart rate variability or galvanic skin response, and this study supports the findings of those studies, suggesting psychological and physical benefits for individuals with cLBP through accessing nature.
But of course, as noted above, study participants felt that they lacked adequate accessibility to nature to enjoy it fully. This includes proximity, ground surface texture, amenities, and affordances.
After all, in the case of cLBP, the quality of the person’s walking and gait is negatively impacted by factors like hypersensitivity, avoidance, heightened pain fear, kinesiophobia (an excessive irrational and debilitating fear of movement), and allodynia (a condition in which a stimulus that does not provoke pain triggers painful sensation).
For study participants, traveling to natural spaces was difficult or impossible due to physical disabilities, local spatial limitations such as living in an urbanized area, and a lack of independent modes of transportation. The study stated:
“This lack of reliable, convenient, or safe access to nature spaces was, at best, frustrating to the present sample, and at worst, exacerbated their symptoms.”
The researchers emphasized the importance of accessing green spaces in urbanized areas. This is necessary for cardiovascular health through exercise, respiratory relief from air pollution, mental health, and overall well-being from relaxation and restoration.
The study findings suggest an unmet clinical need for inadequate access to nature spaces, limiting their potential efficacy in the self-management of cLBP.
However, the study had limitations such as the sample size being in the 50–65 age range and comprising almost entirely women, as such, the researchers noted the need for further research with greater inclusion of all individuals with cLBP to develop therapeutic interventions by either implementing real-world adaptations or bringing nature closer or indoors.
Virtual Nature Offers A Technological Bridge to Healing
Exposure to nature could potentially offer a cost-effective, efficacious, and enjoyable means to assist the self-management of cLBP.
However, obstacles such as uneven terrain, limited seating, or difficulties in leaving their homes present challenges for many individuals, preventing patients from taking advantage of its restorative properties.
So, the researchers are working with people suffering from different kinds of chronic pain to develop virtual reality (VR) innovations and test them. These innovations may enable people with chronic pain to experience the benefits of being in nature even when they can’t physically access it.
VR is an immersive technology that can make one feel like they’re in another world. By putting on a VR headset, users get a 360° view of a virtual environment.
Studies have shown4 that exposure to an immersive VR environment can influence how people perceive pain and sensitivity by affecting the brain’s natural pain control system and the way the nervous system becomes more sensitive to pain signals, even in people who are otherwise healthy.
A study conducted by researchers from Imperial College London found5 that VR “can reduce the perception of capsaicin-induced ongoing pain and secondary hyperalgesia” (an increased sensitivity to pain).
In fact, the RelieVRx® program is the first FDA-authorized in-home VR treatment for lasting reduction of chronic lower back pain. The US Food and Drug Administration granted the treatment the De Nova approval back in late 2021 after a randomized trial involving 179 people demonstrated the pain levels of those who used the VR devices reduced by more than half after eight weeks of treatment compared with 26% of those who used a device with only a 2D environment.
Research interests in VR-based stress and pain reduction systems have increased over the last few years, likely due to the rise in commercial VR solutions.
And the latest study is also exploring the unmet clinical need of those with chronic low back pain (cLBP) through immersive virtual reality therapy by making natural scenes and stimuli more accessible.
“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.”
– Dr. Hughes
Investing in Virtual Reality Tech
The Virtual Reality (VR) market is a big and growing one. It is not only transforming the gaming and entertainment sector by allowing users to engage in a simulated environment, but also the education, automotive, and healthcare industries.
A major player in this sector is Alphabet (GOOG +3.01%), the parent company of Google, which is actively involved in VR technology through various initiatives and investments.
The tech giant has been exploring VR for years, focusing on various aspects, including VR content, devices, and platforms. It is also working with Samsung to develop VR and mixed reality (MR) headsets. Earlier this year, the company bought part of HTC’s XR business for $250 million in order to boost its AR, VR, and XR business as well as the Android XR platform development across headsets and glasses.
Last year, it also partnered with augmented reality startup Magic Leap to build immersive experiences. Google is an investor in the company that boasts expertise in optics and device manufacturing, which is majority-owned by Saudi Arabia’s Public Investment Fund.
Alphabet Inc. (GOOG +3.01%)
Alphabet primarily operates via Google Cloud, Google Services, and Other Bets. The Google Services segment encompasses Chrome, Search, Android, YouTube, Google Play, and Google Maps, while the Google Cloud segment comprises infrastructure, collaboration tools, and other services tailored for enterprise customers.
The Other Bets segment of Alphabet is engaged in a diverse collection of experimental and long-term ventures such as Waymo, Verily, and Google Fiber.
The focus of Alphabet’s Verily, as shared by its Chairman and CEO Stephen Gillett, is on offering “precision health to everyone, every day.”
The health-tech company brings together broad expertise in medicine, science, technology, and engineering into one place to solve ambitious problems. It is also leveraging AI to develop strong technical and clinical capabilities.
Back in 2018, Verily launched its first chronic care and chronic disease management offering called Onduo, which is now being moved into Lightpath. Coming out early next year, Lightpath will expand Onduo’s capabilities to address multiple chronic conditions, including hypertension, type 1 diabetes, and obesity.
Now, let’s take a look at Alphabet’s market performance. The $2 trillion market cap company’s shares are trading at $169.43, down 11.14% YTD but not far from its ATH, only 17.5%.
It has an EPS (TTM) of 8.97 and a P/E (TTM) of 18.75. The dividend yield you get here is 0.50%. Recently, the company announced a 5% increase in its dividend, which puts the quarterly cash dividend at $0.21. In April 2025, Alphabet also got the authorization to buy back up to an additional $70 billion of its shares.
Alphabet Inc. (GOOG +3.01%)
As for company financials, the tech behemoth reported revenue of $90.2 billion for the first quarter of fiscal year 2025. The revenue increased 12% YoY, “reflecting robust momentum across the business,” while total operating income increased 20% and net income surged 46%. With a 49% increase, EPS was $2.81.
“Underpinning this growth is our unique full-stack approach to AI,” said CEO Sundar Pichai, who noted the rollout of the company’s most intelligent AI model, Gemini 2.5. Driven by Google One and YouTube, it surpassed 270 million paid subscriptions.
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Conclusion
As the global economic burden of chronic lower back pain (cLBP) continues to rise, technological advancements offer a solution to help relieve the burden on society as well as the patients suffering from cLBP.
Nature is critical in providing distraction from this pain and connecting with others, but for many, this healing is out of reach, a challenge that can be overcome through virtual nature.
Virtual reality is emerging as a powerful solution for restoration. So, as researchers continue to gain a better understanding of its impact on pain while technology advances and the healthcare system catches up, these restorative experiences may soon become accessible to all, helping millions effectively manage their pain and live a healthier and more fulfilling life!
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Studies Referenced:
1. GBD 2021 Low Back Pain Collaborators. (2023). Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5(6), e316–e329. https://doi.org/10.1016/S2665-9913(23)00098-X
2. Berry, M. S., Rung, J. M., Crawford, M. C., Yurasek, A. M., Vásquez Ferreiro, A., & Almog, S. (2021). Using greenspace and nature exposure as an adjunctive treatment for opioid and substance use disorders: Preliminary evidence and potential mechanisms. Behavioural Processes, 186, 104344. https://doi.org/10.1016/j.beproc.2021.104344
3. Smith, A., Wyles, K. J., Schofield, P., & Hughes, S. (2025). “Being away from everything”: Exploring the importance of access to nature for individuals living with chronic low back pain. The Journal of Pain. Advance online publication. https://doi.org/10.1016/j.jpain.2025.105440
4. Mehesz, E., Karoui, H., Strutton, P. H., & Hughes, S. W. (2021). Exposure to an immersive virtual reality environment can modulate perceptual correlates of endogenous analgesia and central sensitization in healthy volunteers. The Journal of Pain, 22(6), 707–714. https://doi.org/10.1016/j.jpain.2020.12.007
5. Mehesz, E., Karoui, H., Strutton, P. H., & Hughes, S. W. (2021). Exposure to an immersive virtual reality environment can modulate perceptual correlates of endogenous analgesia and central sensitization in healthy volunteers. The Journal of Pain, 22(6), 707–714. https://doi.org/10.1016/j.jpain.2020.12.007