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Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms

  • Hassan Jafari
    Correspondence
    Address reprint requests to Hassan Jafari, PhD, Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Box 3726, 3000 Leuven, Belgium.
    Affiliations
    KU Leuven - University of Leuven, Research Group Health Psychology, Leuven, Belgium

    Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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  • Ali Gholamrezaei
    Affiliations
    KU Leuven - University of Leuven, Research Group Health Psychology, Leuven, Belgium

    KU Leuven - University of Leuven, Department Chronic Diseases, Metabolism & Ageing (CHROMETA), Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
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  • Mathijs Franssen
    Affiliations
    KU Leuven - University of Leuven, Research Group Health Psychology, Leuven, Belgium

    Center for the Psychology of Learning and Experimental Psychopathology, University of Leuven, Leuven, Belgium
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  • Lukas Van Oudenhove
    Affiliations
    KU Leuven - University of Leuven, Department Chronic Diseases, Metabolism & Ageing (CHROMETA), Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
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  • Qasim Aziz
    Affiliations
    Wingate Institute of Neurogastroenterology, Centre for Neuroscience and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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  • Omer Van den Bergh
    Affiliations
    KU Leuven - University of Leuven, Research Group Health Psychology, Leuven, Belgium
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  • Johan W.S. Vlaeyen
    Affiliations
    KU Leuven - University of Leuven, Research Group Health Psychology, Leuven, Belgium

    Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
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  • Ilse Van Diest
    Affiliations
    KU Leuven - University of Leuven, Research Group Health Psychology, Leuven, Belgium
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Published:January 21, 2020DOI:https://doi.org/10.1016/j.jpain.2019.12.010

      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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