What if “take a deep breath” isn’t always good advice for pain?
Updated: 15 hours ago
Any woman who has given birth knows this moment. Managing the pain of childbirth with deep breathing. Trying to get some space from intensity.
“Take a slow, deep breath” has been advised for people struggling with many challenges.
Stress? Breathe slowly and deeply.
Anxiety? Take some slow deep breaths
Pain? Take a deep breath
While it sounds pretty harmless, I'm challenging that advice - today through the lens of persistent or chronic pain. Because sometimes, taking a bigger breath isn't helping your body regulate. It may actually be adding another layer to an existing pain loop.
Full transparency, I've had plenty of injuries in my life but I don't personally manage chronic pain. But now I can look back at my own personal experiences of managing acute pain and guiding others through the breathing through the behavioural lens.
A personal example of managing acute pain is during my first pregnancy when I experienced regular, excruciating gallbladder attacks. I couldn't take pain medication, so I did what was common knowledge and seemed intuitive: I breathed slowly and deeply to manage the intense 12/10 pain.
Big, audible breaths while on all fours waiting for the pain to go away. If you've experienced this, you know what I'm talking about. Negotiating with God that I'll never eat another french fry ever (which, of course I did), and trying to stay calm between rounds of vomiting and not knowing how long the pain would last this time.
When the time came to give birth to our son, I was feeling pretty darn confident about my ability to handle the pain of natural childbirth. After all, I was now thoroughly conditioned trained in breathing through pain like a champion. I wore it like a medal. literally recall saying 'Bring it on.'
During later stages of birth, I had a full out of body experience.
I described my labour as a 'spiritual experience' because I was certain I crossed over into other realms (somewhere between the tremoring and throwing up). A lotta big loud breaths. Fast forward 20 years armed with an education in respiratory physiology and breathing behaviour, I can look back on that experience with an understanding of what was really happening.
I was severely hypocapnic (low arterial C02), which altered my chemistry and physiology.
During the intense pain of labour, I was over ventilating in response to pain: that is, I was breathing off CO₂ faster than my body was producing it. This decreased my and the baby's oxygen perfusion along with my sense of reality and blood flow to my digestive system. This medically explains my hallucinations (hypocapnia is dissociative), vomiting, and why my baby's heart rate was so distressed. It also provides a possible contributing factor to his inability to stay awake to feed for his first 2 weeks of life.
CO₂ isn't just a waste product.
We often think of breathing as simply getting oxygen in and carbon dioxide out. But CO₂ is also a very precious gas that we need to retain just the right amount of in our blood. It regulates blood vessel tone, blood pH, oxygen delivery and cellular oxygen perfusion.
When ventilation exceeds metabolic demand, CO₂ can fall. This can produce changes in pH and vascular tone—including cerebral vasoconstriction—and can affect sensations, cognition, balance and how the nervous system interprets what is happening in the body.
In my case, the over breathing was dramatic enough that the physiological consequences were obvious for me and the baby.
But the dramatic over breathing I'm sharing in my story isn't required to effect someone's physiology.
Your over breathing may be almost invisible:
You may not be gasping for air, you may not feel dizzy. You may not even think you're breathing differently. It might simply be that when pain increases, you unconsciously begin to:
breathe a little deeper
make your breaths a little more audible
sigh often
And because deep breathing is something we've been taught is good for us, we don't question it.
This is where we need to start looking at breathing differently.
Breathing is behavioural, meaning it's learned things along they way from our first breath, through injuries, play, rest and stress. Breathing can alter our internal chemistry and our state immediately within a few breaths. It's behaviour can be adaptive and maladaptive. The breath is intelligent and learns.
Pain itself can change breathing - research has shown that pain can increase respiratory flow, frequency and volume. And while some studies suggest paced slow breathing can reduce pain, the evidence is far from consistent and the mechanisms are still not well understood.
More recent research is beginning to make an even more important point: Different breathing interventions may affect pain differently and study authors are finding that breathing interventions are not one-size-fits-all.
This is about the time I get the question: "So then how should I breathe when I'm in pain?"
I'm not suggesting that slow, deep breathing is “bad", but given not all breathing techniques work for everyone, I offer my clients a much more personalized approach. I like to know things like:
· What happens to your breathing when pain begins?
· Does breathing become deeper? Faster? More effortful? More audible?
· And what happens to your symptoms when your breath changes?
In this workshop for clinicians, we'll look at the relationship between breathing behaviour, respiratory chemistry and pain, including:
• How acute and chronic pain change breathing behaviour
• How over breathing alters CO₂ and pH
• The relationship between CO₂, vascular tone and oxygen delivery
• How breathing chemistry influences cognition, balance and sensory experience
• Why “just take a deep breath” isn't necessarily an appropriate intervention for everyone (based on research)
• How to recognize subtle breathing behaviours that may be contributing to a client's pain experience
• Practical ways to bring breathing awareness into clinical work without creating another performance task for the client
And we'll do more than talk about it. Participants will experience it.
Because respiratory physiology makes a lot more sense when you can feel the difference between breathing more and breathing better.
If you're a clinician working with people experiencing persistent pain, this workshop will give you another lens through which to understand your clients' experience and tools to support their growing awareness.
Pssst...If you are a birth pro coaching women how to breath during labour, you want to study with LV Kusch of Conspire Health. I wish I had known about this when I was having babies.
And if you live with chronic pain yourself, I hope this gives you a little curiosity rather than another thing to worry about. You haven't been breathing “wrong.” You've been using a strategy you've been taught and most people never question. The question is whether that strategy is serving you and I can help you determine that. Book a free 15 minute consult to discuss your symptoms and hear about my unique approach.
Lastly, remember that better breathing isn't only learning to breathe more slowly or deeply.
Sometimes it's about learning to understand the breathing you're already doing.
Joy Onyschak is a Somatic Practitioner and Certified Breathing Behaviour Analyst based in Winnipeg and Manitou, MB, Canada. She helps people struggling with nervous system dysregulation who are seeking body-based solutions to regain their resiliency, befriend their bodies, and become present for their lives. Learn more about her work at: https://www.joysomatics.ca
Book a workshop or private session: https://www.joysomatics.ca/bookings
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