Do Cardiorespiratory Variables Predict the Antinociceptive Effects of Deep and Slow Breathing?


  • Financial disclosures/Conflicts of interest: Matthias Zunhammer is supported by a scholarship from the German National Academic Foundation. This research received no other specific grant from any funding agency in the public, commercial, or not-for-profit sectors. None of the authors has any conflict of interest to disclose.

Reprint requests to: Matthias Zunhammer, MSc, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstrasse 84, 93053 Regensburg, Germany. Tel: +49-176-600-16738; Fax: +49-941-941-2075; E-mail:



Deep and slow breathing (DSB) is a central part of behavioral exercises used for acute and chronic pain management. Its mechanisms of action are incompletely understood.


1) To test the effects of breathing frequency on experimental pain perception in a dose dependent fashion. 2) To test the effects of breathing frequency on cardiorespiratory variables hypothesized to mediate DSB analgesia. 3) To determine the potential of the cardiorespiratory variables to mediate antinociceptive DSB effects by regression analysis.


Single-blind, randomized, crossover trial.


Twenty healthy participants.


Visually paced breathing at 0.14 Hz, 0.10 Hz, 0.06 Hz, and resting frequency.

Outcome Measures.

Cardiorespiratory variables: RR-interval (= 60 seconds/heart rate), standard deviation of the RR-interval (SDRR), and respiratory CO2. Experimental pain measures: heat pain thresholds, cold pain thresholds, pain intensity ratings, and pain unpleasantness ratings.


1) There was no effect of DSB frequency on experimental pain perception. 2) SDRR and respiratory CO2 were significantly modulated by DSB frequency, while RR-interval was not. 3) Baseline-to-DSB and session-to-session differences in RR-interval significantly predicted pain perception within participants: Prolonged RR-intervals predicted lower pain ratings, while shortened RR-intervals predicted higher pain ratings. SDRR and respiratory CO2 were not found to predict pain perception.


The present study could not confirm hypotheses that the antinociceptive effects of DSB are related to changes in breathing frequency, heart rate variability, or hypoventilation/hyperventilation when applied as a short-term intervention. It could confirm the notion that increased cardiac parasympathetic activity is associated with reduced pain perception.