Background/Objectives: Central sensitization (CS) is identified as a cause of pain in various musculoskeletal diseases, and breathing pattern disorders (BPDs) are reported to be correlated with chronic pain. This study aimed to analyze the correlation between CS and BPDs. Methods: A cross-sectional study was designed according to the strengthening the reporting of observational studies in epidemiology (STROBE) guidelines. Forty participants with moderate to extreme CS (central sensitization inventory for Koreans; CSI-K≥40) were enrolled, and their respiratory motion (manual assessment of respiratory motion; MARM), respiratory function (self evaluation of breathing questionnaire; SEBQ), respiratory muscle strength (maximal inspiratory pressure; MIP, maximal expiratory pressure; MEP), pain intensity (numeric pain rating scale; NPRS), pain cognition (Korean version of pain catastrophizing scale; K-PCS), muscle tone and stiffness were measured. Results: Among participants with moderate to extreme CS, 82.5% showed BPDs and 42.5% reported severe pain intensity. K-PCS demonstrated significant correlations with MARM area (r=-0.437) and SEBQ (r=0.528). In the subgroup with BPDs, strong correlations were found between MARM area and NPRS (r=-0.486) and K-PCS (r=-0.605). The regression model for muscle properties showed notably high explanatory power (97.8%). Conclusion: In individuals with moderate to extreme CS, respiratory dysfunction was prevalent and significantly associated with pain intensity and pain cognition. These quantitative relationships between breathing mechanics, pain measures, and muscle properties suggest the importance of assessing breathing patterns in CS management.