Breathe in, breathe out…
We all breathe. It is most an automatic, unconscious experience. We can over-ride it by purposefully holding our breath, or consciously changing the rate or depth of our breathing. You may notice that when you are under stress, you tend to hold your breath or have quick and shallow breaths. We can counteract this effect by breathing exercises.
Breathing exercises have been used since time immemorial for relaxing the mind and body, and are common in yogic and meditation practices. When we breathe deeply and slowly, it sends a message to the brain to slow down, and begins a process to relax the body and mind.
In addition to being used for relaxation and contemplation, breath work is often used to manage sleep, stress, anxiety, high blood pressure and pain. For example, rhythmic, patterned breathing is well-known as a labour pain technique. In spite of the variety and range of breathing techniques, their efficacy and mechanisms of action are unclear.
Fight or flight?
To understand the body’s relaxation response, we will look at two opposing forces – the sympathetic and parasympathetic nervous systems. The sympathetic nervous system elicits the “fight or flight (or freeze)” response. This is a physiological reaction that occurs in response to a perceived threat. Its purpose is to co-ordinate increased strength and speed in anticipation of fighting or running. Activation of the fight or flight response is characterized by faster heart and breathing rate, dry mouth, slowed digestion, muscle tension and sweating.
The body releases stress hormones such as adrenaline and cortisol that prepare the body to fight or escape. Trauma or stress can also cause freezing, where the body goes into a protective but paralyzing adaptive response. In today’s society, the sympathetic nervous system is often chronically over activated, resulting in anxiety, irritability and depression.
In contrast, the parasympathetic, or “rest and digest” response is active when the body is at rest, especially after eating, and including during sexual arousal, salivation, urination, digestion and defecation. This system conserves energy, slows the heart rate and increases gut motility. The relaxation response is a state of “safety” that dampens the physical and emotional responses to stress, resulting in reduced heart rate, blood pressure, breathing rate, and relaxes muscles. It is during this phase when healing occurs.
It should be noted that this is just one way in which breathing could alter pain, and there are numerous other mechanisms that may result in reduced pain, such as cardiovascular responses, endogenous opioids or neurotransmitter release, and an analgesic effect of distraction due to focusing on breathing instead of painful symptoms.
What is the scientific evidence for respiration-induced analgesia?
A number of studies have attempted to ascertain the effect of breathing on pain responses. Research in the ‘80s showed that patients with chronic pain hyperventilated, which normalised after relief from pain (Glynn et al, 1981). Deep and slow rhythmic breathing was shown to reduce postoperative pain, blood pressure, heart rate and muscle tension in patients who underwent coronary artery bypass surgery (Miller, 1987). Chalaye and colleagues (2009) reported higher heat pain thresholds and tolerance in healthy individuals during slow deep breathing which was associated with changes in heart rate activity. In a study of 16 healthy subjects, deep and slow “relaxing” breathing was shown to increase pain thresholds and decrease sympathetic nervous system activity (Busch et al, 2012). It should be noted that deep “attentive” breathing did not change these measures. Both interventions reduced tension, anger, and depression.
Breathing exercises can effectively reduce pain and decrease reliance on opioids. Indeed, relaxation techniques are simple and effective non-pharmacological options to complement pharmaceutical treatments. Next time you are watching TV, waiting in a queue, or trying to fall asleep, why not try some of these breathing exercises?
The 4-6-8 technique: Breathe in for 4 seconds, hold for 6 seconds, and breathe out for 8 seconds. A longer exhale activates the parasympathetic nervous system. Imagine that sigh of relief as you sit down after a long day.
Diaphragmatic breathing helps you slow down your breathing when feeling stressed. Babies instinctively breathe this way, which is also used by yogis, musicians and singers.
- Lie down with one hand on your chest and the other on your stomach.
- Feel the hand on your abdomen rise as you fill your lungs with air, expanding your chest
- Let your breath passively exit your lungs
Insight Timer: Free app with numerous guided meditations, and a timer with background tracks to breathe along to.
Dr. Nikita Burke is a postdoctoral researcher examining the neurobiology of pain, with a focus on microglia and opioids. Also see: https://calgaryneuropathy.com/about-us/ to learn more about Dr. Nikita Burke.