How to Use Breathing Techniques to Control Chronic Pain

The shift in breathing that happens when we’re in pain—or get relief from pain—is undeniable. We gasp and then hold our breath when there’s a sudden, sharp pain. We let out a long sigh when a painful episode ends. However, if the pain lingers, our breath quickens and gets more shallow and we may even hyperventilate if the intensity feels unbearable.

But just as our respiration changes in response to pain, slowing and deepening our breathing can have the opposite effect, taking the edge off the pain. (There’s a reason pregnant people often practice Lamaze breathing before going into labor.) A 2017 review in the journal Pain suggests pain affects breathing via increasing its flow, frequency, and volume. The researchers found an association between paced slow breathing and reduced pain.

Medical professionals and yoga therapists swear by simple breathing exercises, such as mindfully observing inhales and exhales and then gradually lengthening the exhales, for decreasing pain and distress in people in chronic pain.

“We may not be able to make the pain go away, but we can learn to work with it and to start to reduce our stress signals, says Shailla Vaidya, MD, a former emergency medicine physician and certified yoga therapist who practices mind-body medicine for stress resilience in Toronto, Canada. “Fighting pain is so much worse. We tense up more and go into a stress feedback loop, which increases pain signals. Working with the breath is a way to bring us out of that stress response so we can build new patterns of function and gain a sense of agency back.”

How breath practice works

The pain center of your brain is located in the insula of your temporal lobe—right next to the limbic system that triggers your stress response—and there are neural networks that connect these areas. When you’re in pain, it triggers your sympathetic (fight or flight) nervous system, according to the Clinical Anatomy of the Cranial Nerves. Breath practices are believed to stimulate the parasympathetic (rest and digest, pause and plan, calm and clear) nervous system and shift you out of the fight-or-flight stress response so that you’re in a state where the pain can seem a lot more manageable.

Pain is also complex and you may have lots of added things going on physically and psychologically that are amping it up and making the situation worse. “You have the pain, but you also have all the muscular tension that results from the pain and all the anxiety and fear and frustration. Breath practices can help alleviate those other pieces to bring more ease to the pain or diminish it,” says Marlysa Sullivan, PT, C-IAYT, a physiotherapist, co-editor of Yoga and Science in Pain Care, and an assistant professor in integrative health sciences at Maryland University of Integrative Health in Laurel, Maryland.

There are breathing techniques that can help you manage your pain. The best part about using your breath is that it’s available to you all the time and in any situation. Start with breath awareness and elongated exhales, and then experiment to see what gives you the most relief. “Sometimes we underestimate [the] power of the breath. It’s often the simple things that are the most effective,” Sullivan says.

You may also want to join a support group for pain and consult with a yoga therapist certified through the International Association of Yoga Therapists who can teach you options (there are up to 34 types of pranayama, the yoga practice of breath control) and give you individualized advice. To get started, here are six yogic breathing techniques  to try.

Breath awareness

“The simple practice of observing your breath is a mindful technique that allows you to cue into something outside of your physical pain,” says Priya Verma, PAC, C-IYAT, a certified physician assistant and certified yoga therapist in Marietta, Georgia, who specializes in non-pharmacological pain management and has worked with patients in orthopedic surgery, sports medicine, and allergy, and asthma.

To practice breath awareness, also called beginner’s breath, start by paying attention to your breath. Notice how your body moves when you inhale and how it moves when you exhale, Dr. Vaidya says. When your mind starts to wander, acknowledge what you’re thinking but bring your focus back to the breath. Start with one minute and build up to 10 or 15 minutes if you have the time.

You can also try lying down and placing a hand on your belly. As you breathe, notice if your belly rises on the inhale and falls on the exhale. After a few breaths, place your hands on the side of your ribs and notice if you feel the breath there, Sullivan says.

Elongated exhale

There’s a reason we have the phrases “a sigh of relief” and “waiting to exhale.” An exhale means we’re OK. “You can use your exhalation to bring yourself out of the sympathetic stimulation that may be making your pain response worse,” Dr. Vaidya says. “When you start to exhale, you send signals up to the brain that this must be a good time and you can relax now.”

Begin with breath awareness and then focus on gently elongating your exhale without forcing it, Dr. Vaidya says. As you do this, your breathing may become less shallow. If your chest feels tight or constricted, try breathing into your back. “Many of us tense up in the front when we’re stressed as an evolutionary response to protect our big organs. Send your breath to wherever there is room,” Dr. Vaidya adds.

You can also try breathing in through your nose and release the breath through an open mouth with a sigh-like sound, which may help elongate the exhale. This technique is called ujjayi pranayama and Verma has used it to help orthopedics patients prepare and recover from major surgery, prepare for painful procedures, and during physical therapy at home. Practice it for three to five minutes and then try it the next time you are getting up or moving in a way that tends to be painful.

Visualization

Visualization can also aid in lengthening your exhale. Imagine that a little mirror is in front of your mouth. On each exhalation, think about trying to warm the mirror with your breath to form condensation, Verma suggests. You can also try imagining that you’re stepping outside on a cool, crisp morning. As you exhale, visualize breath vapors forming in the coolness of the air.

Another option is to think about ocean waves coming in and out. Follow that beautiful cadence with your inhales and exhales, Verma says. Continue a visualization practice for two to five minutes and slowly feel the expansion of your body on the inhale and emptying of the breath on the exhale.

As your exhales become longer, you may also start linking your breathing to a mantra or a wish for yourself and then visualize that you are turning toward the pain and breathing into the pain spot instead of fighting it, Dr. Vaidya advises.

Paced slow deep breathing

Paced slow deep breathing is commonly used in pain research and in hospital settings. Breathe in for about five seconds and breathe out for five seconds. As you repeat this slow pattern, it can bring your breath rate to about six breaths per minute, which may be about half of your normal breath rate. (An adult respiratory rate can be anywhere from 12 to 20 breaths per minute.)

If you find this uncomfortable, stop focusing on the counts. Our experts recommend using breath awareness and elongated exhales to naturally bring yourself into slow deep breathing instead of forcing it and struggling through it, which can cause an unintended stress response that’s counterproductive.

solidcolours/Getty ImagesAlternate nostril breathing

The rhythmic technique of alternate nostril breathing, or nadi shodhana pranayama, is an advanced practice that can be used as a tool to help pull you out of stress response, Dr. Vaidya says. Alternate nostril breathing has also been shown to reduce blood pressure and increase heart-rate variability, or fluctuations in the timing between heart beats. An increase in heart rate variability is a marker of general health and well-being.

Bring your right hand to your nose. Gently place your thumb to your right nostril and your ring finger to your left nostril. Close the right nostril with your thumb. Exhale out of the left nostril, pause briefly, then inhale through the left nostril. Close your left nostril with your ring finger and release the pressure of your thumb. Exhale through your right nostril. Pause, then inhale through the right nostril. Close your right nostril with your thumb and release your ring finger. Repeat the cycle for 3 to 5 minutes, ending with an exhale out of your left nostril. Alternatively, you can visualize the left and right movements of the breath without bringing your fingers to your nose.

The pause between each inhale and exhale can improve the profusion of oxygen across your lungs, but it can also be a triggering or anxiety-provoking, Dr. Vaidya says. If it’s uncomfortable in any way or you start to feel panicky, stop the practice.

Bee breath

Bee Breath, also known as bhramari pranayama, creates a soothing sound that may help you relax or ease anxiety, according to a 2018 study published in the Journal of Traditional and Complementary Medicine. It’s yet another tool to help elongate your exhale.

Inhale, then keep your mouth gently closed on the exhale to allow for a gentle humming or buzzing sound. If you’re comfortable with the sound, continue for three to five minutes.

You can also experiment with different vowel sounds on the exhale.

The most important thing with any of these breath practices is to pay attention to how each makes you feel and what your pain feels like over time. Try to sit quietly for a few minutes after each practice to observe how you feel. Start slow and experiment until you find what works best for you.