Breathing therapy as a supplement to opioid management for complex chronic non-cancer pain conditions - a systematic review

Clinical Snapshot

Key Findings

• P Value: Statistically significant results in six of ten studies

• Effect Size: Up to 37% pain reduction in two low-bias studies examining daily slow diaphragmatic breathing

• Primary Outcome: Pain reduction and health-related quality of life improvement

• Nnt Or Sensitivity: Not calculable due to heterogeneity and lack of pooled analysis

• Confidence Interval: Not reported due to inability to pool results

Clinical Application

Daily 15-minute slow diaphragmatic breathing appears feasible and low-risk intervention Relevant to Australian chronic pain management guidelines emphasising multimodal non-pharmacological approaches. Could complement PBS-subsidised pain medications and align with RACGP chronic pain management recommendations Adult patients with chronic neck pain, low back pain, fibromyalgia, or tension-type headache seeking non-pharmacological pain management

Abstract

OBJECTIVES: The purpose of this systematic review was to analyze whether breathing therapy is effective in reducing pain, improving health-related quality of life, improving physical functioning/activity, and improving sleep quality in patients suffering from complex chronic non-cancer pain conditions (CNCP). CONTENT: An electronic literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Library, PEDro, and PsycINFO from inception to October 2024. The inclusion criteria were randomized clinical trials (RCT) examining breathing therapy as a sole or central intervention component in adult patients with CNCP. From 2,369 abstracts, a total of 10 RCTs (n=638) met the inclusion criteria. The population in the selected studies were patients with chronic neck pain, chronic low back pain, fibromyalgia, or tension-typed headache. Breathing therapy significantly improved pain and/or health-related quality of life in six studies. However, the quality of the included RCTs ranged from high to critically low, and substantial heterogeneity in participants, intervention, and methods prevented synthesis of results across studies. SUMMARY: This systematic review highlights breathing therapy as a promising pain management strategy in patients suffering from CNCP. We evaluated two RCTs examining similar daily slow diaphragmatic breathing for 15 min to have a low risk of bias; both demonstrating statistically significant relevant pain reduction up to 37 %. However, the strength of recommendations for clinical practice depends on the level of evidence as indicated by a risk of bias assessment (internal validity), consistency of results between studies, and generalizability (external validity). Based on the findings of this systematic review evidence of breathing therapy invention in patients suffering from CNCP conditions remains sparse. OUTLOOK: Striving to eliminate or minimize opioid management for complex CNCP, high-quality research is needed to reinforce the evidence base for non-pharmacological interventions such as breathing therapy to support modern pain management rather than former traditional pharmacological treatment. Trial registry number: PROSPERO #CRD42023460181.

References

1. 1.Mikkelsen, L. M. S., & Loving, S. W. (2026). Breathing therapy as a supplement to opioid management for complex chronic non-cancer pain conditions - a systematic review. Scandinavian Journal of Pain. https://doi.org/10.1093/ptj/pzy025