Dr Michael Mosley shows how to beat chronic pain simply by breathing

As a medical student, I once heard a surgeon tell a woman he was looking after: ‘Pain is just nature’s way of telling you that you are a real patient.’ I think, beneath the cynicism, he was getting at an important fact: that chronic pain is both common and hard to treat.

The simplest thing to expect as a patient is a prescription for a painkillers. You take them and hope it does the trick. Sometimes it does, often it doesn’t. So what are the alternatives?

First, you have to make a distinction between acute and chronic pain. Acute, immediate pain is a natural part of life. It is there to protect us.

You touch a hot stove, feel pain, and immediately draw your hand back. But our pain signalling systems can go wrong. Instead of calming down, they go on firing long after an original injury has healed, leading to chronic pain.


Three-four-five breathing

Breathe in slowly through your nose to a count of three, then hold for four seconds, before you breathe out for five. You can do this any time you feel stressed or in pain.

Four square breathing

Find somewhere comfortable to sit or lie down. Then breathe in slowly through your nose to a count of four, hold it, then breathe out through your mouth to a count of four. Do this ten times. You should feel yourself relaxing and the pain beginning to ease. Try to do this at least four or five times a day.

Alternative nostril breathing

This is a well-known yoga exercise, also known as nadi shodhana pranayama, meaning ‘subtle energy clearing breathing technique’.

Sit somewhere comfortable. Start by breathing out through your mouth and then use your right thumb to close your right nostril.

Breathe in deeply through your left nostril to a count of four. Really fill your belly. Now switch sides. Block your left nostril with your thumb and breathe out fully to a count of four. Repeat ten times.

A recent study found that this kind of exercise led to a drop in blood pressure in volunteers and also helped them perform better in dexterity and hand-eye co-ordination tasks.

If you feel at all dizzy, which I did the first time I tried this, then you are trying too hard. Don’t push yourself. This is supposed to be relaxing.

I know someone who, two years ago, jarred his spine coming down stairs and has been in pain ever since. The number of people who live with chronic pain – lasting three months or more – is huge. 

According to a survey by the British Pain Society, 40 per cent of the UK population – about 28 million adults – are living with chronic pain and half of them say that pain is moderately or even severely disabling.

There can be an obvious, underlying condition, such as cancer or arthritis, but often there isn’t.

We don’t really know why it happens, but we do know that an injury to the back is often the cause, that women are more likely to experience chronic pain than men, and that it becomes more common with age.

If you live in a state of chronic stress or pain, your nervous system will stay on permanent high alert, with your muscles in a constant state of tension. (File image)


Apart from a dodgy right knee, I am relatively pain-free, but it is a subject I am really interested in.

So I was intrigued to read a fascinating new book called The Meaning Of Pain by osteopath Nick Potter. Nick himself suffers from a chronic back injury. This still, occasionally, flares up, so he knows what long-term pain can do to you, mentally and physically.

He writes well about the science and offers plenty of self-help tips.

But one of the things that really surprised me is the emphasis he places on breathing. As he says in his book: ‘Every one of my patients has it drummed into them that if they don’t do their breathing exercises then there is no point in coming back.’

Breathing is such a basic thing that it is hard to see how doing it differently can reduce pain. Yet as he and others have pointed out, chronic pain is closely linked to stress, and learning how to do ‘controlled breathing’ is an important part of treatment for managing both. That’s partly because pain and stress have a similar effect on the body. They increase your heart rate and blood pressure, make breathing faster and shallower and cause muscles to tighten up.

If you live in a state of chronic stress or pain, your nervous system will stay on permanent high alert, with your muscles in a constant state of tension.

And it’s not just your body. Stress and pain make your levels of stress hormones surge, which in turn will keep your brain in a state of constant arousal. You will be more sensitive to pain signals and be much more aware of them. One way to help break this vicious circle is to practise deep breathing exercises.


Sit down in a hard-backed chair. Put one hand on your chest and your other hand just below your rib cage, resting on your belly. Take a few slow deep breaths. Which of your hands is moving the most? 

If it is the hand on your chest, you are a ‘chest breather’. People in pain often take rapid, shallow breaths and tend to unconsciously hold their breath, leading to increased tension.

Do you have a question for Dr Mosley? 

Email drmosley@mailonsunday.co.uk or write to him at The Mail on Sunday, 2 Derry Street, London W8 5TT. 

Dr Mosley can only answer in a general context and cannot give personal replies. 

If, however, the hand on your belly moves the most, you are a ‘diaphragm breather’, which is a good thing. 

By taking long, deep breaths, you are forcing your diaphragm, the big muscle that lies beneath the lungs, downwards, making your belly expand. This reduces tension and stress.

You can practise: take a slow, gentle, deep breath through your nose, deep down into the bottom of your lungs. It should feel as if you are blowing up a big balloon in your belly. Check that your belly is expanding but your chest is hardly moving. This may be the opposite to what you normally do, but most people soon get the knack.

There is some science to it. A 2016 study published in BMC Complementary And Alternative Medicine found that yoga breathing for just 20 minutes was able to lower stress-related compounds in the saliva of volunteers.

In this study, instructors taught participants to inhale for two counts, hold for eight counts, and exhale for four counts – two-eight-four breathing. But there are lots of different deep breathing exercises you can try. On this page are three I’ve used, which advocates say may help you cope with pain.

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