Breathing technique in pain and cognitive function: a systematic review of the literature
Abstract
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.
References
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://
doi.org/ 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.
org/10.1513/AnnalsATS.201803-198OC
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. https://doi.org/ 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. https://doi.org/10.1016/j.ajog.2017.04.030
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.https://doi.org/10.1016/j.neuroscience.
07.048
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. https://doi.org/10.3233/BMR-160679
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. https://doi.org/10.1002/14651858.CD011008.pub2
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. https://doi.org/10.1134/S2079057017030031
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. https://doi.org/10.1016/j.
ctcp.2016.11.004
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. https://doi.org/10.1002/14651858.CD013031.pub2
Choo, J. K., Simons, E. F. & Sheikh, A. (2018). Glucocorticoids for the treatment of anaphylaxis. Cochrane Database of Systematic Reviews, 65(10), 1205–1211. https://doi.org/10.1111/j.1398-9995.2010.02424.x
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. https://doi.org/10.1002/jcsm.12146
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. https://doi.org/10.2147/CIA.S79560
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. https://doi.org/10.1111/nmo.12760
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. https://doi.org/10.1002/14651858.CD009931.pub2
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. https://doi.org/10.1007/s10072-019-3707-0
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. https://doi.org/10.4103/1119-3077.179279
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. https://doi.org/10.1249/MSS.0000000000000385
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. https://doi.org/10.1002/14651858.CD009075.pub3
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. https://doi.org/10.1016/j.ctim.2016.10.006
Lee, A. L., Gordon, C. S. & Osadnik, C. R. (2018). Exercise training for bronchiectasis. Cochrane Database of Systematic Reviews, (8), 1–12. https://doi.org/10.1002/14651858.CD013110
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. https://doi.org/10.1177/0300060515607385
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. https://doi.org/10.3233/BMR-170839
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:// doi.org/10.1002/14651858.CD010824.pub2
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. https://doi.org/10.1002/14651858.CD011456
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. https://doi.org/10.1002/14651858.cd010969.pub2
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. https://doi.org/10.1016/j.ctim.2018.02.006
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. https://doi.org/10.12659/MSM.921295
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. https://doi.org/10.12659/MSM.913036
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. https://doi.org/10.1089/ham.2018.0074
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. https://doi.org/10.1007/s10549-015-3351-1 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. https://doi.org/10.2340/16501977-1992
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. https://doi.org/10.1016/j.jbmt.2018.02.004
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. https://doi.org/10.1002/14651858.CD012346.pub2
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. https://doi.org/10.1016/j.jacr.2018.09.009
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. https://doi.org/10.1002/14651858.CD009424.pub2
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. https://doi.org/10.1097/HNP.0000000000000172
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. https://doi.org/10.1016/j.explore.
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. https://doi.org/10.1016/j.burns.2016.06.014
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. https://doi.org/10.1016/j.amjmed.2016.03.002
Skoglund, L. & Jansson, E. (2007). Qigong reduces stress in computer operators. Complementary Therapies in Clinical Practice, 13(2), 78–84. https://doi.org/10.1016/j.ctcp.2006.09.003
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. https://doi.org/10.1371/journal.pone.0177228
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. https://doi.org/10.1007/s00384-015-2286-7
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. https://doi.org/10.1002/14651858.CD004085.pub4
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. https://doi.org/10.12659/MSM.896599
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. https://doi.org/10.1186/s12906-016-1271-1
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. https://doi.org/10.1089/acm.2017.0335
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. https://doi.org/10.1016/j.ctcp.2019.02.006
Vojislav, M., Ramanathana, D. & Mishraa, J. (2020). Respiratory regulation & interactions with neurocognitive circuitry. Neuroscience & Biobehavioral Reviews, 112, 95–106. https://doi.org/10.1016/j.neubiorev. 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. https://doi.org/10.1002/14651858.CD010698.pub2
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. https://doi.org/10.1002/14651858.CD012404.pub2
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. https://doi.org/10.1515/jcim-2017-0167
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. https://doi.org/10.1016/S2095- 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. https://doi.org/10.1002/14651858.CD007939.pub2
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