Ascellus Blog

Deep Breathing Can Reduce Fear and Lessen Chronic Pain

November 26, 2018

Deep Breathing Can Reduce Fear and Lessen Chronic Pain


The more you fear pain, the more you feel pain. That fact, backed up by years of research, helps explain why some injured workers with seemingly simple conditions end up with debilitating chronic pain.  They don’t understand why they are in pain, don’t know when it might be triggered, and don’t want to do anything that might exacerbate it. This may lead to avoidance behavior, where they do little if anything of a physical nature in an effort to prevent causing more pain.

Fortunately, there are solutions to this dilemma. Providers can simplify their explanations of the physical diagnoses, and appropriately-trained psychologists can help injured workers understand how their brains are hindering their pain-relieving efforts and teach them the skills to reduce their fears — and their pain.

The Brain’s Role

Pain travels via the nerves from the injured area of the body to the brain’s sympathetic pain response, sympathetic meaning it automatically occurs. In this case, the heart rate, blood pressure and breathing pace all increase with the onset of the pain. This leads to an increase in the stress arousal — the part of the brain where the fight/flight/freeze response is created. The result is an increase in the pain experience.

Using physiological techniques, the injured worker can control his fear level and, in turn, his pain. Typically, there is a pleasure response in the brain that counteracts pain. Over an extended period of chronic pain, however, the pleasure response does not work to reduce the pain. Through various exercises, the pleasure response can be reintroduced.

Here’s an example of a technique to demonstrate. This exercise has the person hold his breath, then feel an instant pleasure once he starts to breathe again.

Here are the steps:

  • Inhale for a count of 3 seconds.
  • Exhale for another count of 3 seconds, so there is no breath in the lungs.
  • Hold the breath for 10 seconds.
  • Take a breath.

A sense of relief, the pleasure response kicks in. This simple exercise introduces the concept of how the pleasure response can help relieve pain.

Chronic pain patients who are gripped with fear need ways to activate the brain’s pleasure response. They can start by learning to control the sympathetic physical responses.

Deep breathing

We know that a cognitive shift takes place during fear invoked by pain, which enhances the threat perception and aggravates the fear and other negative feelings and emotions that only serve to make the pain experience worse. Controlling the physical reactions helps control the brain, and helps the injured worker regain control of his pain and his body.

Breathing can actually help regulate the heart rate and blood pressure, which helps regulate the pain response in the brain. Deep breathing, also known as diaphragmatic breathing can help manage chronic pain and it is an important technique used to help injured workers.

When we inhale the heart rate increases, and when we exhale it decreases. With shallow, chest breathing, blood flow occurs mainly in the lower lobes of the lungs, preventing the injured worker from getting a good, deep breath. This results in less oxygen transferring to the blood. Diaphragmatic breathing allows for more oxygen in the lungs and the blood, and stimulates the relaxation response. It also affects the vagal nerve in ways we are just beginning to understand.

Deep breathing must come from the diaphragm, not the chest. The injured worker can ensure he’s doing it properly by placing one hand on the chest, one on the belly, and taking a deep breath. The diaphragm, rather than the chest should inflate.

Doing up to 10 such deep, slow breaths per minute for several minutes daily helps immediately reduce the heart rate and blood pressure. Practicing it on a regular basis will make deep breathing a habit.

Unlearning Pain

Have you ever wondered why someone’s pain decreases after he takes a placebo? Even though the person has only taken a sugar pill, his belief that he has taken medication aimed at reducing the pain has tricked his brain and worked. If we teach our brains to do something that distracts it from focusing on the pain, the pain can diminish.

CBT or cognitive behavioral therapy remaps the brain to redirect the signals sent by the nervous system. Changing our thoughts and actions can retrain the brain back to the way it was before the chronic pain.

Here is one simple exercise that has an amazing effect on an injured worker with chronic pain. We tell the person to close his eyes and visualize himself the way he used to move before the injury or illness, as he gets up from a chair, or while walking or doing his job.

Each time he does this he is reenergizing that part of the brain that used to control those nerves and motor function and extinguishing the pain map part of the brain. Practicing this several times a day for six weeks helps shrink the pain map and regrow the other map.


Cognitive behavioral therapy (CBT) is based on the idea that a person’s automatic and possibly unconscious thoughts and beliefs create an over-reactive impression of the pain event. Diaphragmatic breathing is among the CBT techniques to change these automatic physical and cognitive responses. Doing so can greatly lessen the injured worker’s fear and allow him to manage his pain.

Ascellus – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. Ascellus makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.

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Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.