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Breathing Exercises for Pain Relief

Raquel Mejía 6 min read Exercise Tutorials

Slow, deep breathing can lower pain in measurable ways — but only when you do it a specific way. This guide walks you through the technique with the strongest evidence, two safer variations, and what to do if focusing on your breath feels uncomfortable.

Before You Begin

A few notes before your first session — especially if you live with PTSD, TBI, or chronic pain.

  • Body focus can trigger anxiety. For some veterans, paying attention to the breath produces the opposite of relaxation: chest tightness, panic, or feeling detached. This is well documented in trauma populations. If it happens, stop and try one of the variations below.
  • Skip breath holds at first. Holding the breath is part of the freeze response. Box breathing and the 4-7-8 method both ask for long holds — start with the simpler technique below.
  • Eyes open is fine. Soft gaze, feet on the floor, hands on your belly — choose what feels safe.
  • Breathing is a tool, not a cure. It is not a stand-alone treatment for PTSD or chronic pain. Pair it with the rest of your care plan.

The Core Technique: Slow Diaphragmatic Breathing

This is the single technique with the most evidence behind it. A 2022 meta-analysis in the Journal of Evidence-Based Integrative Medicine pooled seven trials and found slow deep breathing reduced pain across the board, with the largest effect in burn pain. A 2025 meta-analysis in Clinical Rehabilitation found similar results for chronic spinal pain. The VA Whole Health Library recommends it as a first-line self-management tool.

Step 1: Get into position

Lie on your back with your knees bent, feet flat. Place one hand on your chest, the other on your belly, just below the rib cage. Sitting upright also works once you have the feel of it.

Step 2: Find the diaphragm

Inhale slowly through your nose. Your belly hand should rise. Your chest hand should barely move. If only the chest hand moves, you are chest breathing — common in pain or stress states. Slow down. Let the air drop into your belly.

Step 3: Pace your breath

Aim for five to seven breaths per minute — roughly twice as slow as normal. A simple rhythm:

  • Inhale through the nose for 4 seconds
  • Exhale through the mouth or nose for 6 seconds
  • No holds. The longer exhale is the active ingredient.

If exact counting feels restrictive, just breathe slower than you would naturally. The pacing matters more than the precise rate.

Step 4: Practice 5—10 minutes, twice daily

Two short sessions per day is the VA protocol. A 2024 meta-analysis of breathing programs for low back pain found meaningful pain change generally appears after about four weeks — short of that, expect immediate calming but not lasting relief.

Two Lower-Risk Variations

If counting feels controlling, or body focus brings anxiety, try one of these.

Pursed-lip breathing. Inhale through the nose, then exhale through pursed lips like blowing out a candle. The pursed lips extend the exhale without counting. Originally a COPD technique; safe and easy for nervous-system regulation.

External-focus breathing. Same diaphragmatic pattern, but instead of feeling your belly, focus on the sensation of air at the tip of your nose or the sound of the breath. Trauma-informed clinicians recommend this when internal body awareness is too activating.

Pair Breathing with Movement

Breathing is most useful when it is part of how you move. A 2025 meta-analysis of 17 trials in chronic low back pain found breathing layered onto core work produced larger pain reductions than core exercises alone. Two practical rules:

  • Exhale on the effort. Lifting, pushing, standing up, climbing stairs — exhale through the work, inhale on the return. Safer than holding the breath (the Valsalva maneuver), with the same force output.
  • Use the breath as a stability cue. A slow exhale before a movement engages the deep abdominal and pelvic floor muscles that support the spine. Especially useful for back pain.

What to Watch For

  • Lightheadedness or tingling. You are over-breathing. Slow down, rest a few normal breaths, resume.
  • Chest still rising. Your shoulders are doing the work. Lie down and use the hand cue until the belly leads.
  • Anxiety, panic, or dissociation. Stop. Open your eyes. Press your feet into the floor and name three things in the room. This is information, not failure — talk to a mental health provider before pushing further.
  • Forcing the rate. If 4—6 seconds feels wrong, breathing slower than usual is enough.

When to Get Help

Bring it up with your PT or physician if:

  • Pain consistently worsens during practice
  • Breath focus reliably triggers panic, flashbacks, or dissociation
  • You have unexplained shortness of breath, chest pain, or new neurological symptoms — these are not breathing-technique problems, they need evaluation
  • After four to six weeks of consistent practice you notice no change in pain, sleep, or function

A physical therapist with cardiopulmonary training can assess your diaphragm directly. Diaphragm dysfunction is common in chronic low back pain and in veterans with a history of mechanical ventilation, and it responds well to treatment.

Sources

  • Slow deep breathing for pain: meta-analysis of 7 RCTs. Journal of Evidence-Based Integrative Medicine, 2022
  • Breathing exercises for spinal pain: meta-analysis of 20 studies. Clinical Rehabilitation, 2025
  • Breathing exercises for chronic non-specific low back pain: meta-analysis of 17 RCTs, 2025
  • Respiratory exercise for low back pain: meta-analysis of 14 publications, 2024
  • Diaphragmatic vs. mindful breathing and HRV: RCT. Mindfulness, 2021
  • HRV biofeedback for veterans with chronic pain: pilot RCT, Dorn VA Medical Center. Global Advances in Health and Medicine, 2014
  • HRV biofeedback for co-occurring PTSD and chronic pain: RCT. Journal of Affective Disorders, 2025
  • Diaphragm dysfunction in chronic low back pain. Journal of Orthopaedic & Sports Physical Therapy, 2012
  • Sudarshan Kriya Yoga vs. Cognitive Processing Therapy in veterans: non-inferiority trial. BMJ Open, 2022
  • VA Whole Health Library: Diaphragmatic Breathing protocol
  • VA/DoD Clinical Practice Guideline for the Management of PTSD and Acute Stress Disorder, 2023