Highlights
- •Paced breathing can reduce pain.
- •The hypoalgesic effect is enhanced when breathing is paced at a lower frequency.
- •The hypoalgesic effect is more pronounced when expiration is longer.
Abstract
Slow deep breathing (SDB) is commonly employed in the management of pain, but the
underlying mechanisms remain equivocal. This study sought to investigate effects of
instructed breathing patterns on experimental heat pain and to explore possible mechanisms
of action. In a within-subject experimental design, healthy volunteers (n = 48) performed
4 breathing patterns: 1) unpaced breathing, 2) paced breathing (PB) at the participant's
spontaneous breathing frequency, 3) SDB at 6 breaths per minute with a high inspiration/expiration
ratio (SDB-H), and 4) SDB at 6 breaths per minute with a low inspiration/expiration
ratio (SDB-L). During presentation of each breathing pattern, participants received
painful heat stimuli of 3 different temperatures and rated each stimulus on pain intensity.
Respiration, heart rate, and blood pressure were recorded. Compared to unpaced breathing,
participants reported less intense pain during each of the 3 instructed breathing
patterns. Among the instructed breathing patterns, pain did not differ between PB
and SDB-H, and SDB-L attenuated pain more than the PB and SDB-H patterns. The latter
effect was paralleled by greater blood pressure variability and baroreflex effectiveness
index during SDB-L. Cardiovascular changes did not mediate the observed effects of
breathing patterns on pain.
Perspectives
SDB is more efficacious to attenuate pain when breathing is paced at a slow rhythm
with an expiration that is long relative to inspiration, but the underlying mechanisms
remain to be elucidated.
Keywords
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Article info
Publication history
Published online: January 21, 2020
Accepted:
December 19,
2019
Received in revised form:
December 6,
2019
Received:
July 11,
2018
Footnotes
This study was supported by the Odysseus Grant “The Psychology of Pain and Disability Research Programme”, projects G.0543.09N and G.0715.10N funded by the Research Foundation - Flanders, Belgium (FWO Vlaanderen), the DBOF funding of the Research Council KU Leuven (DBOF/14/020), and the “Asthenes” long-term structural funding–Methusalem grant by the Flemish Government, Belgium (Meth/15/011); FWO Vlaanderen and the Flemish Government had no role in developing the protocol.
The authors have no conflicts of interest to disclose related to the subject matter of this article.
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.
