We don’t think much about breathing, mostly because we don’t have to. This autonomic reflex occurs in healthy adults whether or not we consider what’s going on when we inhale or exhale. But breath is a remarkable tool we can use to heal a variety of conditions. Breathwork for chronic pain is just one way you can use your own body to heal itself. Here’s how to get started.
What is breathwork?
The term “breathwork” simply means using structured, conscious breathing techniques therapeutically. Although this term is relatively new, the practice goes back thousands of years and is referred to more traditionally as pranayama. Pranayama is a Sanskrit word that combines “prana” (energy) with “yama” (control). The practice of pranayama is simply the control of energy through breathing.
In yoga, pranayama is the practice of moving energy through the energetic channels of the body. Inhaling, breath travels up through the left side of your body. Exhaling, breath travels down through the right side of your body. This yogic practice of breathing is one of the eight limbs of yoga. The goal is to bring more energy to the body and to use the breath therapeutically (more below in the types of breathwork).
Scientifically, when you inhale, your diaphragm moves downward to make space for breath to enter your body. This also opens the chest cavity to make room. As you exhale, the diaphragm moves up, pressing breath back out of the body.
Breathwork activates the vagus nerve in the parasympathetic nervous system. The vagus nerve reaches from deep inside your belly all the way up to the base of the brain. Our parasympathetic nervous system is a “rest and digest” system, only active when we are relaxed and at ease. Breathing lowers cortisol and adrenaline production to encourage the body to relax.
Whether you call it pranayama or science, the idea behind breathwork training is to use the breath to focus the mind, calm anxiety, and fully oxygenate the body. We will discuss breathwork benefits for chronic pain in a moment, but a brief explanation of the types of breathwork available will be helpful first.
Different types of breathing
Breathwork techniques focus on deepening the breath in the body. When we become anxious or stressed, we tend to take shallow, short breaths into the upper part of our lungs. The lungs neither completely inflate nor fully empty, leaving trace carbon dioxide in the lungs and inadequately oxygenating the body. The results of this type of shallow breathing mimics the effects of hyperventilation. Our bodies and brains experience a heightened sense of stress and anxiety, both of which can increase pain sensations.
At its most basic, breathwork for chronic pain slows down breathing to approximately half of the normal speed. Breaths begin in the lower belly and gradually inflate the lungs, then slowly release, with the belly deflating last.
Holotropic breathwork is a type of breathwork guided by certified practitioners of the Grof Transpersonal Training program. Conducted in a group, participants help each other and create a supportive network both in and out of the therapeutic setting.
Yoga breathing for pain relief has specific techniques that can also help treat anxiety that often accompanies pain (discussed below).
What are the major breathwork benefits?
The study of breathwork benefits is a relatively new field. Laypeople are not the only ones to take breath for granted – researchers have also not paid much attention to the value of deep, even breath when it comes to our overall health and well-being.
However, the field of research is catching up. Major studies illuminating the benefits of breathwork include these key insights:
- Deep, yogic breathing alleviated major depression in patients who were previously unresponsive to treatment
- Breathing therapy works better than cognitive behavioral therapy to reduce panic and anxiety
- Rhythm of breathing affects memory and fear
- People with severe PTSD who are unable to regulate their breath benefit from device-guided breathing (essentially, guided breathwork)
- Longitudinal studies of veterans with PTSD have also shown that breathwork that stimulates the vagus nerve helps to calm and quiet racing thoughts and anxiety
Another major breathwork benefit is now coming to light: breathwork for chronic pain.
How could breathwork for chronic pain work?
Remember when you were little and scraped your knee, so badly that the skin came away and pain started immediately? Chances are, fear of the accident that caused the scrape combined with pain made your breath short and shallow. Maybe you cried so hard you had trouble catching your breath, even forgetting about it until a caregiver reminded you to breathe.
Breathwork for pain is the grown-up version of comforting that small child in pain. And it works.
Research on pain perception and mood has found that deep and slow breathing reduces autonomic activity (the fear-based, fight-or-flight response) and pain scores.
Another study found that pain scores in women with fibromyalgia decreased drastically in a cascading effect. The more pain decreased, and the more they kept breathing deeply, the more pain decreased.
Even when chronic pain alters a person’s physiology, breathwork for pain relief is effective. One study of patients with chronic lower back pain and altered core muscle activation and breathing patterns found that breathwork significantly decreased pain.
And when pain levels do not decrease as a direct result of breathwork? Other research shows an improved quality of life in chronic pain sufferers. Why? The deep breathing helps patients to better cope with stress and anxiety that often surround dealing with a chronic condition.
The mechanism behind breathwork for chronic pain is not well-understood. Breathing does not remove pain, necessarily, but it does alter a person’s perception of it. Practically speaking, better oxygenation of the blood improves healing, and lowered levels of cortisol and adrenaline allow your body to rest and relax instead of tensing with pain.
In essence, breathwork changes not only your perception of pain but also your body’s response to it.
How to start breathwork for pain
Breathwork training can begin in the comfort of your own home. Think of breathwork as a form of meditation in that a regular practice makes it easier. If you struggle with staying on track, use an app for meditation or breathwork. Following are some tips to get started, along with specific breathwork for chronic pain practices.
First, wear comfortable clothes to practice. You can use breathwork for chronic pain wherever you are, but when you are learning specific techniques, start slowly in a comfortable space. You can sit or lie down, whichever allows you to relax and settle in without strain or additional pain.
If you are lying down, you can support your lower back by bending your knees and placing a pillow or two underneath them. Let your feet be flat on the floor and use a pillow to support your lower back.
Close your eyes and try these six breathwork techniques (arranged from least to most complicated).
1. Deep and slow breathing
This is the simplest type of breathwork you can find, accessible to all.
Focus on taking gradually deeper breaths, inhaling through your nose to the count of four and exhaling through your nose to the count of four. Then inhaling to the count of five and exhaling to the count of five. Keep going, slowly increasing the count but not pushing or stressing about how long you can inhale.
Reach a comfortable count, then take ten deep breaths there. Counting will keep your mind focused on your breath.
2. Deep and slow breathing, part 2
Another technique for deep and slow breathing changes the exhale slightly in one of two ways.
- Relax your jaw and let your exhale come through an open mouth with a gentle “haaaa” sound
- Exhale through the nose, but let your exhale be twice as long as your inhale
The first option releases tension you are holding in your jaw, which can then signal the brain to relax a bit more.
The second option activates the vagus nerve to slow your heart rate quickly. This triggers the brain’s relaxation response more quickly than just inhaling and exhaling might.
3. Three-part breath
Consider your breath in three parts (this is easiest done lying down).
Inhale, letting your belly inflate, then continue to inhale, feeling your ribs expand and open, then keep inhaling, maybe feeling a lift in your collarbones.
Exhale, relaxing your collarbones, drawing ribs together and down, and letting your navel fall towards your spine.
Note that you may not feel much lift in the collarbones at first. Most of us rarely breathe so deeply. Do not force any breath in or push any breath out. Just start where you are and allow your body to gradually open up.
4. Samavritti (square breath, or equal ratio)
The first pranayama for pain relief is samavritti, or square breath. Inhale to the count of four, hold for the count of four, exhale for the count of four, hold for the count of four.
This breath is excellent for teaching awareness of the breath and focusing your mind on something other than chronic pain.
5. Bhramari (bee breath)
Named for the buzzing sound you create when you practice this form of pranayama, bee breath is an excellent antidote to the anxiety that can accompany chronic pain. It also relieves tension and irritation you may be feeling.
Bhramari also reduces heart rate, a key component of managing the stress of chronic pain.
The simplest way to practice bee breath is to place your fingertips on the tragus in the ear (the bit of cartilage between your cheek and the ear opening. Take a deep breath in. As you exhale, press the tragus to seal your ears and hum on the exhalation. This will automatically slow down your exhalation and calm your mind as it does.
You can also use a more complicated hand placement to close off your eyes, nose, and the corners of your mouth.
6. Nadi shodhana (alternate nostril breathing)
This type of yoga breathing for pain relief may feel complicated to start but becomes easier with practice. Many yogis swear by this breath’s benefits in terms of focus, clarity, and generally balancing the entire body.
It is easiest to visualize with a video, but here are the basic steps:
- Close off the right nostril
- Inhale to the count of four through the left
- Close off both nostrils and pause for the count of four
- Exhale through the right nostril to the count of eight
Reverse the process (inhale right, close and pause, exhale left) for one complete cycle of breath.
Learn more about breathwork for chronic pain
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