Breathwork as a Pain-Relief Strategy (Plus 2 Practices for Beginners)

Editor's note: The below are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional.

If you're human, you've probably felt pain. However, all pain is not created equal. Pain is personal, emotional, and instinctual. The experience of pain is completely unique for each person, and pain levels are always gauged relative to other pain experiences or pain-free states.

There is no standardized test for pain. There is a pain scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine. If you are lucky and haven’t experienced much pain in your life, your perception of the level of a new onset of pain could be a 10/10—the worst pain you could imagine. Another person with a similar onset of new pain, but with a previous experience of passing a kidney stone, might call their current pain level a 5/10 compared with that of the kidney stone (which they felt was a 10/10).

Because pain is influenced by previous personal experience, along with feelings and opinions stored in the mind, it is subjective. Understanding this makes it easier to see how your mental conditioning can influence it. That’s why mind-body techniques can be so beneficial in pain management. Since your mind processes pain, your mind can also help unravel it.

In my 28 years as a physician helping people heal their pain, I have found that some of the most potent pain-relieving tools are breathing practices. Some breathing techniques can be irritating to your nervous system, but many others can calm the nervous system. Think about childbirth. One of the most natural techniques for easing labor pain is slow, focused breathing. Why couldn’t something that works for one kind of pain—the pain of childbirth—be effective in alleviating other kinds of pain?

In fact, yogis have for millennia understood the power of breathwork. Pranayama is the Sanskrit word for “the practice of harnessing the life force associated with the breath for optimal health of the body and mind.” Pranayama is highlighted in the Yoga Sutra, a seminal yogic text, as a means for calming and clarifying the mind.

If you have persistent pain, you may be inclined to try to distance yourself from your body, attempting to ignore your pain. But by distancing yourself from your body, you also distance yourself from your body’s innate ability to heal itself. Breathing helps you to connect with your body. Breathing is automatic, but it can also be controlled voluntarily. By consciously working with the breath, you can influence the parasympathetic nervous system, change your heart rate and heart rate variability, and even alter brain wave activity. Clinical studies have also shown that breathwork can reduce anxiety and negative thoughts.

Memories of pain, like all other memories (conscious or not), are called samskaras (mental grooves or habit patterns) in Sanskrit. The purpose of remembering pain is to be able to use that information to prevent future pain (for example, a child touches a hot stovetop, feels incredible pain, and knows not to do that again). Unfortunately, though, chronic or habitual pain can create an increased sense of threat, or hypervigilance, which can increase stress—so that persistent pain can mean unrelenting stress. All that stress activates our sympathetic (“fight or flight”) nervous system (as does persistent worrying: Am I going to get fired? Is my kid going to get hurt skateboarding? Did I forget to buy apples?). 

Slow breathing, on the other hand, activates the vagus nerve of the parasympathetic (“rest and digest”) nervous system, which produces the body’s relaxation response. The parasympathetic nervous system is nature’s brake for the sympathetic nervous system’s effect on the body. It’s the antidote to the “fight or flight” response.

Your breathing can reveal your stress level. Shallow breathing is a common response to stress, while deep, slow breathing is the cornerstone of relaxation. Dr. Herbert Benson at Harvard Medical School has outlined the steps of what he calls the Relaxation Response (the foundation of which is deep, slow breathing). A slower breathing rate can reduce pain and increase your sense of control, and it can shift your EEG pattern from beta to alpha. (Beta waves are present during active thinking, problem solving, and concentration, when your attention is focused on the external world. Alpha waves are present during meditation and are related to creativity, improved mood, exercise, and relaxation.) And, as Christopher Bergland explains in this article, “Depression and anxiety have also been linked to beta waves because they can lead to ‘rut-like’ thinking patterns.”

Shallow breathing is a common response to stress, while deep, slow breathing is the cornerstone of relaxation.

A couple of minutes of deep breathing can produce benefits for hours. Because it reduces sensitivity to pain, it is one of the best drug-free treatments for pain. It is safe, inexpensive, and requires no equipment.

Here are two time-tested breathing practices to get you started:

Diaphragmatic Breathing

This is a basic breathing practice that is accessible to everyone and can immediately provide benefits. It can also be done anywhere. Sit, stand, or lie down on your back. Place your hands on your abdomen. Inhale slowly through your nose, feeling your abdomen rise against your hands and allowing your ribs to expand. Then exhale slowly through your nose, feeling your abdomen release and your ribs relax.

Continue this breathing for as long as you wish. Start with five to ten minutes.

Remember that you deserve some time to recharge.

Alternate Nostril Breathing (Nadi Shodhana)

This practice can calm the nervous system and improve heart rate variability (the variation in the time between heartbeats).

Find a comfortable seat so that your back is tall and your head, neck, and trunk are aligned.

Breathe diaphragmatically, slowly and continuously, without any pauses or jerks. Close your eyes or soften your gaze.

You will use your right thumb and right ring finger to close your nostrils as you breathe during this exercise. To begin, rest your right thumb lightly against your right nostril, and your right ring finger against your left nostril. Inhale through both nostrils.

Then gently close your right nostril with your thumb and exhale through your left nostril.

Then gently close your left nostril and inhale through your right nostril.

Now close your right nostril and exhale through your left nostril again. Repeat this pattern (exhale left, inhale right) for a total of three rounds.

Next gently close your left nostril and exhale through your right nostril. Then gently close your right nostril and inhale through your left nostril.

Continue this pattern (exhale right, inhale left) for a total of three rounds. After your third and final inhale through your left nostril, lower your hand and exhale through both nostrils. Take three normal breaths.

This completes the first cycle of alternate nostril breathing.

Repeat the entire cycle two more times for a total of three cycles, or 27 breaths.

(Go here for a video tutorial of alternate nostril breathing.)

If you want a real-life example of how alternate nostril breathing can alleviate pain, you may have heard last year that Hillary Clinton was interviewed by Anderson Cooper about her new book, What Happened. In the interview, she revealed that alternate nostril breathing was instrumental in enabling her to process the stress of losing the presidential election.

Social rejection and physical pain are felt within the same areas in our brains. While the nerve pathways they use are not identical, there are overlapping nerve circuits between physical and social pain. (For anatomy enthusiasts, those areas are the medial prefrontal cortex and the anterior cingulate cortex.) These areas are known to be involved in negative emotions and noticing unfavorable outcomes, especially in relation to one’s own self.

Research also shows that alternate nostril breathing can help in the management of various experiences of pain. It can improve oxygen flow to our muscles, ease the anxiety associated with taking tests, and increase parasympathetic tone.

So the next time you are dealing with pain, remember that a helpful tool is right under your nose. Don’t forget to breathe.

Editor's note: If you're interested in Dr. Oswald's course Pain Solutions in a Whole New Light, she has an in-person event coming up in June! You can also get a free download of her recent “10 Steps to Pain Relief.”

Sources:

1. MacKinnon, S., Gevirtz, R., McCraty, R., & Brown, M. (2013). Utilizing heartbeat evoked potentials to identify cardiac regulation of vagal afferents during emotion and resonant breathing. Applied Psychophysiology and Biofeedback.

2. Brown, R.P., Gerbarg, P.L. (2005). Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I—neurophysiologic model. Journal of Alternative and Complementary Medicine.

3. Brown, R.P., Gerbarg, P.L. (2005). Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression: part II—clinical applications and guidelines. Journal of Alternative and Complementary Medicine.

4. Katzman, M.A., Vermani, M., Gerbarg, P.L., Brown, R.P., Lorio, C., Davis, M., Tsirgielis, D. (2012). A multicomponent yoga-based, breath intervention program as an adjunctive treatment in patients suffering from generalized anxiety disorder with or without comorbidities. International Journal of Yoga.

5. Descilo, T., Vedamurtachar, A., Gerbarg, P., Nagaraja, D., Gangadhar, B., Damodaran, B., Brown, R. (2010). Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 Southeast Asia tsunami. Acta Psychiatrica Scandinavica.

6. Zautra, A.J., Fasman, R., Davis, M.D., Craig, A.D. (2010). The effects of slow breathing on affective responses to pain stimuli: an experimental study. International Association for the Study of Pain.

7. Busch, V., Magerl, W., Kern, U., Haas, J., Hajak, G., Eichhammer, P. (2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing—an experimental study. Pain Medicine (Malden, Mass.).

8. Chalaye, P., Goffaux, P., Lafrenaye, S., Marchand, S., (2009). Respiratory effects on experimental heat pain and cardiac activity. Pain Medicine (Malden, Mass.).

9. Chalaye, P., Goffaux, P., Lafrenaye, S., & Marchand, S. (2009). Respiratory effects on experimental heat pain and cardiac activity. Pain Medicine (Malden, Mass.).

10. Busch, V., Magerl, W., Kern, U., Haas, J., Hajak, G., & Eichhammer, P. (2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing—an experimental study. Pain Medicine (Malden, Mass.).

11. Eisenberger, N.I., Jarcho, J.M., Lieberman, M.D., & Naliboff, B.D. (2006). An experimental study of shared sensitivity to physical pain and social rejection. International Association for the Study of Pain.

12. Nemati, A. (2014). The effect of pranayama on test anxiety and test performance. International Journal of Yoga.

13. Sinha, A.N., Deepak, D., & Gusain, V.S. (2013). Assessment of the effects of pranayama/alternate nostril breathing on the parasympathetic nervous system in young adults. Journal of Clinical and Diagnostic Research.

14. Ghiya, Shreya, Lee, C. Matthew (2012). Influence of alternate nostril breathing on heart rate variability in non-practitioners of yogic breathing. International Journal of Yoga. 2012 Jan-Jun; 5(1): 66–69.

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Theresa Oswald, MD

Theresa Oswald, MD

Dr. Theresa Oswald brings over 25 years of experience working successfully with patients in the field of pain management to teach you how to transform your pain. Board-certified in integrative... Read more>>