Breathing and pain perception
Exploring the connection
Breathing is an automatic function that sustains our lives, but did you know it holds a remarkable influence over our pain perception? There is a deep connection between breathing and how we experience pain. Understanding the profound impact of breath on pain perception can empower us to harness its potential as a natural tool for pain management.
The physiology of pain perception
The physiology of pain perception involves a complex interplay of sensory signals and neural pathways within the human body. When tissue damage or injury occurs, specialized nerve endings called nociceptors are activated in response to noxious stimuli, such as heat, pressure, or chemicals released from injured cells. These nociceptors are found throughout the body, including the skin, muscles, and internal organs. Once activated, they transmit pain signals through peripheral nerves to the spinal cord and ultimately to the brain.
At the spinal cord level, the pain signals are processed and modulated by various neural circuits. Some signals are amplified, while others may be dampened or inhibited. This modulation helps determine the intensity and nature of the pain experienced. The brain then receives the processed pain signals and interprets them, incorporating emotional and cognitive factors, such as memories and expectations, which influence the overall pain experience.
The thalamus, a central relay station in the brain, plays a crucial role in transmitting pain signals to higher brain regions, including the somatosensory cortex, which is responsible for localizing and identifying the pain’s location and characteristics. Additionally, pain perception involves activation of various brain regions, such as the anterior cingulate cortex and the prefrontal cortex, which are associated with emotional processing, attention, and decision-making. These brain regions contribute to the emotional and cognitive aspects of pain perception, influencing an individual’s pain experience and coping mechanisms.
Recent research suggests that our breath has a direct impact on a numbers of body functions, including pain perception. This article from Russo (2017) represents one of the most comprehensive overview on the effects of deep and slow breathing. In particular:
Generally coincides with increased tidal volume and may enhance diaphragmatic excursion [16, 18]Enhances ventilation efficiency and arterial oxygenation via alveolar recruitment, and distension and reduction of alveolar dead space [23, 24]Moderates chemoreflex sensitivity 
Increases venous return → increases filling of the right heart → increases stroke volume → increases cardiac output [29, 30, 32, 35]Causes blood pressure pulse fluctuations to synchronise with heart beat rhythm Synchronisation of vasomotion May entrain and enhance vasomotion (and microflow), i.e. to improve blood oxygenation Increases HRV and blood pressure fluctuations [21, 41, 42, 62]May decrease mean blood pressure [30, 41, 43, 44]
Augments LF HRV and baroreflex sensitivity [41, 60, 65, 66, 77]Increases RSA (maximises around 6 breaths per min (resonant frequency)) [41, 61, 62, 72–75]Improves pulmonary gas exchange efficiency [45, 47, 48, 78–80], minimises cardiac work [74, 80, 81],
buffers blood pressure fluctuations [29, 35]Clustering of heartbeats within inspiratory phase (cardiorespiratory coupling) [46, 47]Synchronisation of pulse harmonics of blood flow and heart rhythm 
Autonomic nervous system
Increases vagal activity (vagal tone) [42, 103]Shift towards parasympathetic dominance [42, 105]Augments vagal power (entrainment of cardiac resetting by vagus to respiration phases) [97, 103]Optimises acetylcholine release and hydrolysis at SA node [67, 76]Enhances phasic modulation of sympathetic activity [104, 106]Improves autonomic responsiveness to physical perturbations (i.e. standing) Optimises sympathovagal balance 
Also this vast systematic review from Jafari (2017) brings some results on the table regarding how breathing affects and modulates pain perception. In particular, the effects of deep, slow breathing on: blood pressure, respiratory sinus arrythmia and much more.
Slow deep breathing can modulate pain perception through various physiological mechanisms that involve the autonomic nervous system and the brain. When individuals engage in slow deep breathing techniques, such as diaphragmatic breathing or controlled deep breaths, they can experience pain relief and a greater sense of relaxation. Here’s a thorough explanation of how this process works:
Activation of the Parasympathetic Nervous System (PNS): Slow deep breathing triggers the parasympathetic nervous system, which is responsible for the “rest and digest” response. This activation helps counteract the sympathetic nervous system’s “fight or flight” response, which is associated with stress and increased pain perception. The PNS activation leads to a decrease in heart rate, blood pressure, and muscle tension, promoting a state of relaxation that can alleviate pain and discomfort.
Reduction of Stress Hormones: Deep breathing helps reduce the production of stress hormones like cortisol and adrenaline. High levels of cortisol are associated with increased pain sensitivity and can amplify the pain experience. By engaging in slow deep breathing, individuals can lower cortisol levels and create a calmer internal environment, leading to reduced pain perception.
Enhanced Endorphin Release: Deep breathing stimulates the release of endorphins, which are natural painkillers and mood enhancers. Endorphins interact with the brain’s receptors to reduce pain sensations and promote a sense of well-being and euphoria. This increased endorphin release during slow deep breathing can contribute to pain relief and a more positive emotional state.
Distraction and Cognitive Shift: Engaging in slow deep breathing can act as a distraction from the pain, shifting the focus away from the discomfort and onto the rhythmic breathing pattern. This cognitive shift can help individuals manage their pain better and feel more in control of their bodies, reducing the perceived intensity of the pain.
Brainwave Changes: Slow deep breathing can lead to changes in brainwave patterns, specifically an increase in alpha brainwave activity. Alpha waves are associated with a relaxed and meditative state. This shift in brainwave activity can enhance pain tolerance and reduce the emotional distress associated with pain.
Neuroplasticity and Pain Pathways: Chronic pain conditions often involve changes in the neural pathways that process pain signals. Slow deep breathing, when practiced regularly, can contribute to neuroplasticity, the brain’s ability to reorganize and form new neural connections. By promoting neuroplasticity, deep breathing may help reshape pain pathways and decrease the sensitivity of pain receptors.
Relaxation Response: Deep breathing triggers the body’s relaxation response, which involves a series of physiological changes that counteract the stress response. This includes reduced muscle tension, improved blood flow to peripheral tissues, and decreased levels of stress-related chemicals. As a result, pain perception is lessened, and individuals experience a greater sense of well-being.
In summary, slow deep breathing can modulate pain perception by activating the parasympathetic nervous system, reducing stress hormones, enhancing endorphin release, distracting from the pain, inducing brainwave changes, promoting neuroplasticity, and triggering the body’s relaxation response. By incorporating slow deep breathing techniques into daily routines, individuals can effectively manage pain and improve their overall physical and emotional well-being.
Breathing is an inherent part of our lives, yet its influence on pain perception is often overlooked. By recognizing the power of breath and its ability to modulate our experience of pain, we can tap into a natural and accessible tool for pain management. Through mindfulness, intentional breathing, and integration with other holistic practices, we can harness the transformative potential of our breath to enhance our well-being and find relief from pain. Embrace the power of breath and embark on a journey of self-discovery and healing today.
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Dr. Edoardo Elisei DC
Alive Chiropractic LTD
1C Crown Gate Square
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