“Deaths jump five-fold as doctors dole out opioids like Smarties” – Sunday Times, August 28, 2019.
This blog takes as its theme chronic pain and the experience of novelist Tim Parks. This is a topic dealt with in both my book Reclaim Health (which includes a chapter on breath and its role in healing), and Parks’ Teach Us to Sit Still: A Sceptic’s Search for Health and Healing.
“Just when the medical profession had given up on me and I on it, just when I seemed to be walled up in a life sentence of chronic pain, someone proposed a bizarre way out: sit still, they said, and breathe.”
I have recently been re-reading Tim Park’s book Teach us to Sit Still. He focuses on the Buddhist form of meditation where he simply concentrates on the breath – called Anapana. He came to this out of desperation, after chronic pelvic pain had dominated his life. Parks writes:
“When the mind had been tamed and tied down to the breath crossing the lip, like a dog to a chain, then could we progress. In the midst of the usual fierce pains, with a strange naturalness and inevitability, my consciousness at last fused with my upper lip… The breath, the lip, the mind, these apparently incompatible entities did, in fact fit together, flow together, were one [….] In a moment, the lower body sank into suppleness though there had been formless pain, I became aware of thighs, knees, calves, ankles, feet. A strange heat was being forced down through them. My experience that bare feet were cold but a hot pain was passing pleasantly through the soles.’’
He then moved on to Vipassana meditation ‘seeing things as they really are – a process of self-purification by self-observation’. Relatedly, John Cabat-Zinn also gives a full chapter in his book Full Catastrophe Living on the power of breathing to aid relaxation and healing. He highlights that this is your unsuspected ally in the healing process.
Within my own general practice, I introduced ‘meditation to quieten the mind’ through the Phoenix Charitable Trust in 1991, kindly provided by Buddhist monk John Preston. It ran continuously until his death, and was enormously appreciated by many patients suffering from stress related illnesses.
Perhaps relief from chronic pain relates to a fundamental change from over breathing to normal breathing.
Conscious breathing may relieve chronic pain of unknown origin
If courses were provided by the NHS, incorporating mindfulness and stress reduction, then many opioid prescriptions might be saved. The new focus on social prescribing may open the door for this to occur within the NHS at last. The aim of this social prescribing is for a link worker within General Practice to sign-post people to sources of self-care such as the mindfulness courses.
Emotional Healing
The brain’s emotional centres open when under stress to help you pattern match to previous similar episodes of stress. The over-breathing response is carried over as part of your threat response from the time when you needed to become aware of danger. Survival depended on responding to the signals of the approaching sabre-toothed tiger but become less helpful in responding to major concerns about how to pay the mortgage! This is described in Emotional Healing for Dummies, a book which myself (Dr David Beales) and my partner (Helen Whitten) wrote together. It provides a comprehensive programme to recover emotional resilience.
To demonstrate this, the case study below makes the connection between breathing behaviour, physiological change and recovery as functional breathing returns to awareness:
John’s Story: John came to my clinic having been diagnosed with chronic hyperventilation syndrome associated with chronic stress at the Brompton Hospital. This had not been helped by respiratory physiotherapists. He had low levels of carbon dioxide at rest of the order of 25mm of Mercury. He had been unable to work for four months, and had many symptoms of severe anxiety. A validated questionnaire for the chronic hyperventilation syndrome – the Nijmegen Questionnaire consisting of 16 questions – has a specificity of 93% and a reliability of 91%. He scored 56 (Scores above 23 are predictive).
Leading up to the diagnosis he was increasingly troubled by a variety of body-mind symptoms ranging from tension and anxiety to abdominal bloating and difficulty in concentrating. He had also been amid severe family stress after the death of his father. He recovered after breathing re-training, using carbon dioxide feedback, where he was able to regain accuracy in breathing behaviour. This allowed him to restore good carbon dioxide levels and notice the situations where his breathing chemistry was disturbed. The Emotional Healing Process (described below) was combined with cognitive behavioural coaching. He returned to work shortly after.
Please comment on your own experiences or thoughts on alternative approaches to drugs from chronic pain. Should these approaches be part of the NHS?
Dr David Beales 
I can fully endorse this approach as a recently retired GP. We used the 7/11 breathing technique from Dr Grahame Brown’s book ‘How to liberate yourself from pain’. Patients and their doctors were astounded how successful breath control was in relieving symptoms, often relatively quickly.
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Thank you for writing this David. There is copious research into BPD – breathing pattern disorder, showing that it is the underlying cause of many GP visits by patients complaining of chest pains, asthma symptoms, anxiety etc. When we demonstrated the Capno-trainer, a biofeedback system for retraining breath management, to our local GP surgery it was met with disinterest and zero follow up enquiry. I wonder what it will take for doctors to think outside the prescriptive box most dwell in?
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Thanks so much as Sally. The science is sound for the effects of chronic and intermittent hypocapnia on symptom production due to over breathing and evidence-based and yet it doesn’t enter the health service delivery system. As you say.
I used the Capno Trainer in the UK with Peter Litchfield the originator when he came home from the States. I demonstrated on numerous general practice study days. Chronic over breathing, as the hyperventilation syndrome, is an insidious and dangerous state of people to be in for any length of time and usually goes undiagnosed. Breathing retraining appeared in the Nice guidelines for asthma as a recommendation with a number needed to treat for effectiveness of one in six in Mike Thomas’s research.
You ask what would it take but doctors to be interested in the mechanisms of over breathing and the symptoms it produces.
I think a different kind of training where the science of PNI is taught, including breath Physiology as the vital link between mind and body and disturbed by external and internal pressures. The future general practitioner requires extra training in holistic enquiry, proper diagnosis including CO2 testing and breathing retraining to be part of the surgery pathways of treatment. In other words whole person medicine.
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