"It Only Hurts When I'm Breathing" is a song co-written and performed by Canadian country music singer-songwriter Shania Twain. The track was composed by Twain and her then-husband Robert John "Mutt" Lange, and produced by Lange. It was released on February 9, 2004 as the eighth and final single from Twain's album Up!, and the fifth to impact the North American market. Disparate to the remainder of Up!, "It Only Hurts when I'm Breathing" is a ballad that Twain labeled to be the sole heartbreak song on the album. Musically, it lies within the country pop genre while its lyrics speak of misery.

"It Only Hurts When I'm Breathing" received mixed reviews from music critics. Commercially, the single performed well in Canada, where it peaked at number four, and mildly in United States' country and adult contemporary markets. It peaked at number 71 on the Billboard Hot 100 and at number 18 on Hot Country Singles & Tracks. Although an official music video for "It Only Hurts when I'm Breathing" was never filmed, it was given a promotional music video taken from a performance for the concert film Up! Live in Chicago (2003). Contestant Michael Lynche performed a cover version of "It Only Hurts when I'm Breathing" on a Twain-themed episode of the ninth season of the singing competition American Idol.

After collaborating on her great successes The Woman in Me (1995) and Come on Over (1997), Twain and her then-husband Robert John "Mutt" Lange decided to take a musical hiatus. The two relocated to Switzerland, settled down, and had a child, Eja, in August 2001. Twain felt content and was in a very positive state of mind, which inspired Up! (2002). She and Lange conceptualized the album to be very positive, optimistic, and uplifting; they desired to evade dark subject matters, yet still be profound through optimism. In doing so, they co-wrote every track on Up!, in which few tracks were ballads, something Twain considered a small ratio compared to the nineteen songs on the album. She explained it was not done deliberately, but influenced by her and Lange's state of mind at the time, adding, "There just didn't seem to be enough room for [ballads]". One of the ballads was "It Only Hurts when I'm Breathing", which Twain deemed necessary to come down in tempo. She said the song was very powerful and, as with each track on Up!, was significant to her. Twain said of the track, "This is the only heartbreak song on the new CD. [...] a chance for all of us to catch our breath here." "It Only Hurts when I'm Breathing" was later selected as the eighth and final single from Up!, fifth to impact the North American music market. It was released to country radio on February 9, 2004 and to adult contemporary radio on March 22, 2004. A live CD single and digital download were taken from Up! Live in Chicago, and released on March 9, 2004 with the same cover as the video album.CD singles and 7" singles were later issued by Mercury Nashville Records on March 30, 2004.

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