Chronic pain is a widespread, disabling condition than affects an estimated twenty percent of people in the world. Pain is usually regarded as chronic if it lasts or reoccurs for periods of three to six months, which is beyond the normal amount of time for healing. Chronic pain can contribute to anxiety, depression, disability, sleep disturbances, poor quality of life and certainly impacts healthcare costs.

An article published in February, 2018 studied the connection between chronic pain and negative emotion. The researchers required the subjects (with chronic pain) and their spouses (without chronic pain) to track their emotions throughout the day. They concluded that those in chronic pain has significantly more variability in negative emotion than their spouse. There was also a correlation to the amount of pain one was under. Such that, those in higher levels of pain reported stronger levels of negative emotions. This begs the question: can we affect pain levels by improving one’s emotional or mental resilience?

Often in the realm of physiotherapy we use exercise to help with many conditions, especially with chronic pain. Exercise can reduce the severity of pain, as well as improve overall physical and mental health. The type and amount of exercise varies considerably based on the individual, however, the positive affect of exercise is irrefutable. Many studies have tried to examine what kind and how much people with chronic pain should exercise to achieve the best results. There is an increased interest in whether there is an effect of a natural environment vs. a synthetic environment for exercise. A systematic review in 2010, analysed the potential role that a natural environment has on health and wellbeing. They compared exercise in natural environments, such as parks or green spaces and exercise in synthetic environments, such as indoor and outdoor built facilities. The evidence suggests that there is a positive benefit to participating in outdoor exercise, in a natural setting, compared to in a facility.  Perhaps the difference between the two environments is on an emotional level? Are the green spaces improving our emotional capacity, which is helping our ability to manage pain?

There is a growing body of research that suggests even brief encounters with nature improves our overall emotional wellbeing. Time spent in and around gardens, parks, forested areas is consistently linked to positive long-term health outcomes. So, why not suggest that patients with chronic pain exercise in a natural space, hiking, snowshoeing, light walks, perhaps even doing their physiotherapy home exercises in a park. They may even seep in some positive energy while resting on the park bench between sets!