Respiratory therapy - a possible solution in the alleviation of chronic pain

Abstract

Background. Establishing and arguing the interdependence of chronic pain and breathing. Analysis and confirmation of the efficiency of chronic pain management with the help of various respiratory techniques (such as: Pranayama, Deep Slow Breathing (DSB), Abdominal Breathing, etc.). Minimizing or even excluding the coping / improvement of the chronic pain with opioids, finding alternative in respiratory therapy. Pain is a component of many chronic conditions, chronic pain itself constituting a complex, disturbing nosological entity with a strong negative impact on the individual, family and society as a whole. Chronic pain is a major problem in the 21st century, affecting over 1.5 billion people worldwide (most of them constituting: lumbar pain (27%), migraine (15%), sore throat (15%), pain (4%), chronic pain is the number one cause of long-term disability. Another very important aspect is the economic one: in the United States alone, around 560-635 billion dollars is spent on treatment. of chronic pain, more than that there are registered budget losses of 299-325 dollars from the account of the hours and days of work that were missed. The global study of disease burden in 2016 reaffirmed that the increased prominence of pain and accompanying pain are the main cause of disability and burden of disease globally. Only 23% of chronic pain patients said that opioids are effective in their case. Case report. The articles from the years 1984-2020 were selected and analyzed, reinforcing a meta-analysis from the works on PubMed, MEDLINE, EMBASE, Elsevier, Pain Magazine (2010-2019), Pain Medicine (2012), Breathe (2017), Respiratory Medicine (2013) etc. The articles that correspond to the contemporary standards of the scientific study were respectively categorized into 4 types: 1) Experimental studies, 2) Clinical studies studying the effects of pain on respiration, 3) Clinical studies studying the effects of respiratory exercises on selfreported pain and 4) Experimental studies that follow for the purpose of determining the effect of the trained respiratory pattern on the pain induced in laboratory conditions. Most of the clinical studies analyzed (around 75%) report a beneficial pain-relieving effect following at least one of the respiratory techniques. Even if these results are promising other therapeutic active factors such as relaxation, massage, meditation, sea sounds etc. they may be equivalent involved in generating these balance sheets. Conclusions. Following the analysis of studies regarding the association between respiration and pain, both physiologically and psychologically, an interesting and significant connection is determined. Most clinical studies document the benefit of Slow Deep Respiration (SDB) in relation to pain relief, but experimenp tal studies do not consistently achieve this result, as does the case of a direct correlation between breathing and hypoalgesia (an indirect mechanism being more plausible). In the near future the following questions require an answer: 1) Do such psycho-behavioral mechanisms such as concentration, distraction, anticipation and self-control caused by the instructed breathing reduce pain? 2) What other processes central to Deep Slow Breathing (SDB) can induce respiratory hypoalgesia and what can we conclude from the literature on animals in this regard?