Diaphragmatic Breathing and Managing Chronic Pain

Written by Margaret Heaton-Ashby, LMFT

We all know breathing is essential to life. We all do it or else we would not be here. So why emphasize diaphragmatic breathing (DB) and what exactly is it? According to research conducted by the National Institute of Health (2020), diaphragmatic breathing “is slow and deep breathing that affects the brain and the cardiovascular, respiratory, and gastrointestinal systems through the modulation of autonomic nervous functions.” Put in simple terms, DB affects your entire body and has many benefits.

The Mayo Clinic (2019) describes the practice of DB as “taking deep, even paced breaths using the muscles under your rib cage (diaphragm).” The Mayo Clinic continues on to state, “this type of breathing releases natural painkillers (endorphins) into your body.” Not only does DB release “feel-good” neurotransmitters, it is also linked with a host of other benefits outlined in numerous research articles and texts. Time and time again, the most commonly identified benefit of DB is reducing levels of stress and improving relaxation which will be the focus of this article.

Time for a brief science-based interlude. According to Jessica Sweeton (2019), a trauma treatment expert, our body has a built-in defense system that was developed to keep us safe and to keep us alive. This automatic physiological reaction is regulated by our central nervous system and is commonly known as the stress response (AKA: “fight or flight”). When any potential danger is detected, our central nervous system goes into a state of high alert (the fight/flight response is activated) to keep us safe. Not surprisingly, pain is easily perceived as a potential danger, and can cause triggering and activation of the fight/flight response.

In working with clients with chronic pain, we regularly discuss the direct correlation between stress and pain (Otis, 2007). I often hear clients describe the activation of the stress response when experiencing a flare in pain levels. Common physical symptoms include: shallow breathing (breathing from their shoulders, chest) or holding their breath entirely to brace against the pain, a rise in blood pressure, and some even note their blood sugar levels spike. In true fight/flight fashion, thinking patterns are also altered when the stress response is activated. People often experience racing, catastrophic thoughts, such as “This is the worst pain ever!” or “This pain is never going to end!” Consequent hyperfocus on pain, along with disqualifying the positive, such as recalling times when pain levels were more tolerable. Further, emotions such as fear, worry, panic are easily triggered. These types of thoughts and emotional reactions continue to fuel the stress response, causing stress levels to stay on high alert, which in turn keeps pain levels high. Since the entire body is on high alert, the most important first step to take is calm the body down.

Diaphragmatic breathing has been scientifically proven to activate the relaxation response and helps to calm the body down. This is the direct opposite state to the fight/flight response, and is controlled by the central nervous system. Deep, rhythmic, diaphragmatic breathing allows the body to become more regulated, calm and relaxed. As we shift out of the fight/flight state, into a state of relaxation, our pain levels also reduce (do not read “disappear,” they “reduce”). As you calm your body and become more regulated it is easier to think more logically and engage in problem solving. For example, you are able to recall the last time you had a flare and what you did to help ease the pain. Initiating deep breathing when pain triggers the fight/flight response, you are able to move through pain rather than brace against it. It is worth noting, even in the absence of pain, unhelpful thinking patterns and emotional reactions can independently activate the stress response. According to Dr. Bruce Perry, when working with individuals who are in a heightened state the goal is to “regulate, relate, and reason.” As you can see, this fits in with managing pain too. We can use our breath to regulate our body and then we are able to relate to and process our pain in a more helpful way, and from there we can take reasonable steps to further address the pain as needed.

At The Mayo Clinic, Dr. Sweeton and other experts advise that the most effective way to integrate diaphragmatic breathing in order to receive optimal benefits is to engage in deep breathing for 5-10 minutes, three times per day. This practice alone will begin to shift the way you relate to pain and other stressors in your life. When engaging in the practice, I’d strongly encourage you to turn your attention to the sensation of the breath. Notice the feeling of your belly rising and falling with the breath or the gentle flow of air passing through the nostrils or mouth as you engage in slow controlled inhalation and exhalation. When you focus your attention towards the actions of your breathing, you are tuning out negativity, catastrophic thinking, worry, fear, pessimism and working to shift away from the hyperfocus on pain. This further assists in reducing the stress response and reducing your pain levels.

Our breath is powerful. It gives us life. It heals us. It gives us the space and capacity to tolerate stress. Use it!