Breathing technique in pain and cognitive function: a systematic review of the literature

  • Juan Pablo Alzate-Granados Universidad de la Costa. Barranquilla (Colombia)
  • Armando Solarte Universidad de la Costa. Barranquilla (Colombia)
  • Pedro Javier Lopez Universidad de la Costa. Barranquilla (Colombia)
  • Ernesto Barceló Universidad de la Costa. Barranquilla (Colombia)



Breathing techniques are key components of yoga, meditation and relaxation practices that are well known for reducing anxiety and improving overall well-being. To evaluate the efficacy of breathing techniques in pain and cognitive function. We conducted a literature review searching the main literature databases (medline, lilacs, Cochrane library) including randomized clinical trials. We assessed the risk of bias of the included studies using the methodology proposed by the Cochrane collaboration. In total, we found 16 studies that met the inclusion criteria, with an intermediate or unclear overall risk of bias. When combining the different breathing techniques vs control in the included studies, we found a statistically significant difference in terms of the visual analog scale (Difference of means, random effects; -1.21 [95% CI -1.75 to -0.68]; I2: 95%). Meditation-based breathing techniques would improve pain and cognitive function in patients with a painful entity or healthy volunteers.

Keywords: Breathing techniques, Pain, Cognitive function, Systematic review, Breath holding


Aamann, L., Dam, G., Rinnov, A. R., Vilstrup, H. & Gluud, L. L. (2018). Physical exercise for people with cirrhosis. Cochrane Database of Systematic Reviews, (12), 1–42. https:// 10.1002/14651858.cd012678.pub2

Abdallah, S. J., Smith, B. M., Ware, M. A., Moore, M., Li, P. Z., Bourbeau, J. & Jensen, D. (2018). Effect of Vaporized Cannabis on Exertional Breathlessness and Exercise Endurance in Advanced Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial. Annals of the American Thoracic Society, 15(10), 1146–1158. https://doi.


Abedi, P., Jahanfar, S., Namvar, F. & Lee, J. (2016). Breastfeeding or nipple stimulation for reducing postpartum

haemorrhage in the third stage of labour. Cochrane Database of Systematic Reviews, (1), 1–32. 10.1002/14651858.CD010845.pub2

Altenau, B., Crisp, C. C., Devaiah, C. G. & Lambers, D. S. (2017). Randomized controlled trial of intravenous acetaminophen for postcesarean delivery pain control. American Journal of Obstetrics & Gynecology, 217(3), 362.e361–362.e366.

Arsenault, M, Ladouceur, A., Lehmann, A., Rainville, P. & Piché, M. (2013). Pain modulation induced by respiration: phase and frequency effects. Neuroscience, 12(252), 501–511.


Babina, R., Mohanty, P. P. & Pattnaik, M. (2016). Effect of thoracic mobilization on respiratory parameters in

chronic non-specific low back pain: A randomized controlled trial. Journal of Back & Musculoskeletal Rehabilitation, 29(3), 587–595.

Barnes, H., McDonald, J., Smallwood, N. & Manser, R. (2019). Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. Cochrane Database of Systematic Reviews, (3), 1–103.

Bayer, U., Glazachev, O. S., Likar, R., Burtscher, M., Kofler, W., Pinter, G., Stettner, H., Demschar, S., Trummer, B. & Neuwersch, S. (2017). [Adaptation to intermittent hypoxia-hyperoxia improves cognitive performance and exercise tolerance in elderly]. Advances in Gerontology, 7(3), 214–220.

Boaviagem, A., Melo Junior, E., Lubambo, L., Sousa, P., Aragao, C., Albuquerque, S. & Lemos, A. (2017). The effectiveness of breathing patterns to control maternal anxiety during the first period of labor: A randomized controlled clinical trial. Complementary Therapies in Clinical Practice, 26, 30–35.


Chan, K. K., Joo, D. A., McRae, A. D., Takwoingi, Y., Premji, Z. A., Lang, E. & Wakai, A. (2019). Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency

department. Cochrane Database of Systematic Reviews, (5), 1–16.

Choo, J. K., Simons, E. F. & Sheikh, A. (2018). Glucocorticoids for the treatment of anaphylaxis. Cochrane Database of Systematic Reviews, 65(10), 1205–1211.

Connolly, B., Salisbury, L., O’Neill, B., Geneen, L. J., Douiri, A., Grocott, P. W. M., Hart, N., Walsh, T. & Blackwood,

B. (2018). Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Journal

of Cachexia, Sarcopenia and Muscle, (7) 1–6.

Ferreira, L., Tanaka, K., Santos-Galduroz, R. F. & Fernandes, J. C. (2015). Respiratory training as strategy to

prevent cognitive decline in aging: a randomized controlled trial. Clinical Interventions in Aging, (10), 593–603.

Frokjaer, J. B., Bergmann, S., Brock, C., Madzak, A., Farmer, A. D., Ellrich, J. & Drewes, A. M. (2016). Modulation of vagal tone enhances gastroduodenal motility and reduces somatic pain sensitivity. Neurogastroenterology &

Motility, 28(4), 592–598.

Gilbert-Kawai, E. T., Mitchell, K., Martin, D., Carlisle, J. & Grocott, P. W. M. (2018). Permissive hypoxaemia versusm normoxaemia for mechanically ventilated critically ill patients. Cochrane Database of Systematic Reviews, (5), 1–18.

Grubić, T., Babić, M. & Štimac, D. (2019). Exploring the feasibility of a mild and short 4-week combined upper limb and breathing exercise program as a possible home base program to decrease fatigue and improve quality of life in ambulatory and non-ambulatory multiple sclerosis individuals. Neurological Sciences, 40(4), 733–743.

Gunay, S., Eser, I., Ozbey, M., Agar, M., Koruk, I. & Kurkcuoglu, I. C. (2016). Evaluation of two different respiratory physiotherapy methods after thoracoscopy with regard to arterial blood gas, respiratory function test, number of days until discharge, cost analysis, comfort and pain control. Nigerian Journal of Clinical Practice, 19(3), 353– 358.

Janssens, L., McConnell, A. K., Pijnenburg, M., Claeys, K., Goossens, N., Lysens, R., Troosters, T. & Brumagne, S. (2015). Inspiratory muscle training affects proprioceptive use and low back pain. Medicine & Science in Sports & Exercise, 47(1), 12–19.

Knips, L., Bergenthal, N., Streckmann, F., Monsef, I., Elter, T. & Skoetz, N. (2019). Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database of Systematic Reviews, (1), 1–104.

Larkey, L. K., Roe, D. J., Smith, L., & Millstine, D. (2016). Exploratory outcome assessment of Qigong/Tai Chi Easy on breast cancer survivors. Complementary Therapies in Medicine, 29, 196–203.

Lee, A. L., Gordon, C. S. & Osadnik, C. R. (2018). Exercise training for bronchiectasis. Cochrane Database of Systematic Reviews, (8), 1–12.

Lee, J. M., Lee, S. K., Lee, S. J., Hwang, W. S., Jang, S. W. & Park, E. Y. (2016). Comparison of remifentanil

with dexmedetomidine for monitored anaesthesia care in elderly patients during vertebroplasty and kyphoplasty. Journal of International Medical Research, 44(2), 307–316.

Lee, M.-H. & Jang, S.-H. (2019). The effects of the neck stabilization exercise on the muscle activity of trunk respiratory muscles and maximum voluntary ventilation of chronic stroke patients. Journal of Back & Musculoskeletal Rehabilitation, 32(6), 863– 868.

Lewis, S. R., Nicholson, A., Reed, S. S., Kenth, J. J., Alderson, P. & Smith, A. F. (2019). Anaesthetic and sedative agents used for electrical cardioversion. Cochrane Database of Systematic Reviews, (3), 1–78. https://

Mah, G. T., Turgeon, R. D., Loh, G., Tejani, A. M. & Sweet, D. D. (2019). Ketamine and propofol in combination for adult procedural sedation and analgesia in the emergency department. Cochrane Database of Systematic Reviews, (1). 1–21.

Mesgarpour, B., Heidinger, B. H., Roth, D., Schmitz, S., Walsh, C. D. & Herkner, H. (2019). Harms of off-label erythropoiesis-stimulating agents for critically ill people. Cochrane Database of Systematic Reviews, (8), 1–196.

Movahedi, M., Ghafari, S., Nazari, F. & Valiani, M. (2017). The effects of acupressure on pain severity in female nurses with chronic low back pain. Iranian journal of nursing and midwifery research, 22(5), 339–342. https://doi. org/10.4103/ijnmr.IJNMR_108_16

Nyer, M., Gerbarg, P., Silveri, M, Johnston, J., Scott, T., Nauphal, M., Owen, L., Nielsen, G., Mischoulon, D., Brown, R., Fava, M. & Streeter, C. (2018). A randomized controlled dosing study of Iyengar yoga and coherent breathing for the treatment of major depressive disorder: Impact on suicidal ideation and safety findings. Complementary Therapies in Medicine, 37, 136–142.

Oh, Y.-J., Park, S.-H. & Lee, M.-M. (2020). Comparison of Effects of Abdominal Draw-In Lumbar Stabilization Exercises with and without Respiratory Resistance on Women with Low Back Pain: A Randomized Controlled Trial. Medical Science Monitor, 26, e921295-1–e921295-8.

Park, S.-H. & Lee, M.-M. (2019). Effects of a Progressive Stabilization Exercise Program Using Respiratory Resistance for Patients with Lumbar Instability: A Randomized Controlled Trial. Medical Science Monitor, 25, 1740–1748.

Patrician, A., Tymko, M. M., Caldwell, H. G., Howe, C. A., Coombs, G. B., Stone, R., Hamilton, A., Hoiland, R. L. & Ainslie, P. N. (2019). The Effect of an Expiratory Resistance Mask with Dead Space on Sleep, Acute Mountain Sickness, Cognition, and Ventilatory Acclimatizationin Normobaric Hypoxia. High Altitude Medicine & Biology, 20(1), 61–70.

Peppone, L. J., Janelsins, M. C., Kamen, C., Mohile, S. G., Sprod, L. K., Gewandter, J. S., Kirshner, J. J., Gaur, R., Ruzich, J., Esparaz, B. T. & Mustian, K. M. (2015). The effect of YOCAS© R yoga for musculoskeletal symptoms among breast cancer survivors on hormonal therapy. Breast Cancer Research & Treatment, 150(3), 597–604. Pettersson, H., Faager, G. & Westerdahl, E. (2015). Improved oxygenation during standing performance of deep breathing exercises with positive expiratory pressure after cardiac surgery: A randomized controlled trial. Journal of Rehabilitation Medicine, 47(8), 748– 752.

Phattharasupharerk, S., Purepong, N., Eksakulkla, S. & Siriphorn, A. (2019). Effects of Qigong practice in office workers with chronic non-specific low back pain: A randomized control trial. Journal of Bodywork & Movement

Therapies, 23(2), 375–381.

Pollok, J., van Agteren, J. E. M. & Carson- Chahhoud, K. V. (2018). Pharmacological interventions for the treatment of depression in chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (12), 1–53.

Ratcliff, C. G., Prinsloo, S., Chaoul, A., Zepeda, S. G., Cannon, R., Spelman, A., Yang, W. T. & Cohen, L. (2019). A Randomized Controlled Trial of Brief Mindfulness Meditation for Women Undergoing Stereotactic Breast Biopsy.

Journal of the American College of Radiology, 16(5), 691–699.

Rietberg, M. B., Veerbeek, J. M., Gosselink, R., Kwakkel, G. & van Wegen, E. E. H. (2017). Respiratory muscle training for multiple sclerosis. Cochrane Database of Systematic Reviews, (12), 1–37.

Sagkal, T. & Ciray, N. (2016). Effects of Reiki on Pain and Vital Signs When Applied to the Incision Area of the Body After Cesarean Section Surgery: A Single-Blinded, Randomized, Double- Controlled Study. Holistic Nursing

Practice, 30(6), 368–378.

Sagkal, T. S. & Eser, I. (2015). Effects of Reiki on Post-cesarean Delivery Pain, Anxiety, and Hemodynamic Parameters: A Randomized, Controlled Clinical Trial. Pain Management Nursing, 16(3), 388–399. https://doi. org/10.1016/j.pmn.2014.09.005

Saoji, A. A., Raghavendra, B. R., Madle, K. & Manjunath, N. K. (2018). Additional Practice of Yoga Breathing With Intermittent Breath Holding Enhances Psychological Functions in Yoga Practitioners: A Randomized

Controlled Trial. Explore: The Journal of Science & Healing, 14(5), 379–384.

02.005 Seyyed-Rasooli, A., Salehi, F., Mohammadpoorasl, A., Goljaryan, S., Seyyedi, Z. & Thomson, B. (2016).

Comparing the effects of aromatherapy massage and inhalation aromatherapy on anxiety and pain

in burn patients: A single-blind randomized clinical trial. Burns, 42(8), 1774–1780.

Sharon, H., Maron-Katz, A., Ben-Simon, E., Flusser, Y., Hendler, T., Tarrasch, R. & Brill, S. (2016). Mindfulness meditation modulates pain through endogenous opioids. The American Journal of

Medicine, 129(7), 755–758.

Skoglund, L. & Jansson, E. (2007). Qigong reduces stress in computer operators. Complementary Therapies in Clinical Practice, 13(2), 78–84.

Smith, K. E. & Norman, G. J. (2017). Brief relaxation training is not sufficient to alter tolerance to experimental pain in novices. PLoS ONE, 12(5), 1–13.

Smith, S. R., Draganic, B., Pockney, P., Holz, P., Holmes, R., McManus, B. & Carroll, R. (2015). Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial. International Journal of Colorectal Disease, 30(9), 1237–1245.

Sud, S., Sud, M., Friedrich, J. O., Wunsch, H., Meade, M. O., Ferguson, N. D. & Adhikari, K. J. N. (2018). High-frequency oscillatory ventilation versus conventional ventilation for acute respiratory distress syndrome. Cochrane Database of Systematic Reviews, (4). 1–49.

Telles, S., Bhardwaj, A. K., Gupta, R. K., Sharma, S. K., Monro, R. & Balkrishna, A. (2016). A Randomized Controlled Trial to Assess Pain and Magnetic Resonance Imaging-Based (MRI-Based) Structural Spine Changes in Low Back

Pain Patients After Yoga Practice. Medical Science Monitor, 22, 3228–3247.

Telles, S., Sharma, S. K., Gupta, R. K., Bhardwaj, A. K. & Balkrishna, A. (2016). Heart rate variability in chronic low back pain patients randomized to yoga or standard care. BMC Complementary & Alternative Medicine, 16(1), 279.

Tomas-Carus, P., Branco, J. C., Raimundo, A., Parraca, J. A., Batalha, N. & Biehl-Printes, C. (2018). Breathing Exercises Must Be a Real and Effective Intervention to Consider in Women with Fibromyalgia: A Pilot Randomized Controlled Trial. Journal of Alternative & Complementary Medicine, 24(8), 825–832.

Tomas-Carus, P., Garrido, M., Branco, J. C., Castano, M. Y., Gomez, M. A. & Biehl-Printes, C. (2019). Non-supervised breathing exercise regimen in women with fibromyalgia: A quasi- experimental exploratory study. Complementary Therapies in Clinical Practice, 35, 170–176.

Vojislav, M., Ramanathana, D. & Mishraa, J. (2020). Respiratory regulation & interactions with neurocognitive circuitry. Neuroscience & Biobehavioral Reviews, 112, 95–106. 2020.02.001

Wall, B. F., Magee, K., Campbell, S. G. & Zed, P. J. (2019). Capnography versus standard monitoring for emergency department procedural sedation and analgesia. Cochrane Database of Systematic Reviews, (3), 1–42.

Warttig, S., Alderson, P., Evans, J. W. D., Lewis, S. R., Kourbeti, I. S. & Smith, A. F. (2019). Automated monitoring compared to standard care for the early detection of sepsis in critically ill patients. Cochrane Database of Systematic Reviews, (6), 1–25.

Wongwilairat, K., Buranruk, O., Eungpinichpong, W., Puntumetakul, R. & Kantharadussadee-Triamchaisri, S. (2018). Muscle stretching with deep and slow breathing patterns: a pilot study for therapeutic development.

Journal of Complementary & Integrative Medicine, 16(2), 1–9.

Yuksel, H., Cayir, Y., Kosan, Z. & Tastan, K. (2017). Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. The Journal

of Integrative Medicine, 15(6), 456–461. 4964(17)60368-6

Zhang, W. H., Zhang, H., Grant, S. J.,Wan, X. & Li, G. (2018). Single herbal medicine for diabetic retinopathy. Cochrane Database of Systematic Reviews, (12), 1–41.


Download data is not yet available.
How to Cite
Alzate-Granados, J., Solarte, A., Lopez, P., & Barceló, E. (2020). Breathing technique in pain and cognitive function: a systematic review of the literature. Journal of Applied Cognitive Neuroscience, 1(1), 25-42.