Work

Comparative Effectiveness of Pharmacological, Non-Pharmacological, and Combined Strategies for Pain Relief During Colonoscopy: A Bayesian Network Meta-Analysis of Randomized Trials

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background: Colonoscopy is the gold standard for colorectal cancer screening, but procedural pain remains a major barrier to patient compliance. Various pharmacological and non-pharmacological interventions have been developed to improve patient comfort, yet the comparative effectiveness of these strategies remains unclear. Methods: We systematically searched five databases for randomized controlled trials published between 2004 and 2024 that evaluated analgesic interventions for colonoscopy and performed a Bayesian random-effects network meta-analysis. We analyzed two pre-specified subnetworks—non-pharmacological and pharmacological/combined—according to intervention type. The primary outcome was pain on a visual analogue scale. Results: 40 RCTs (5614 participants, 32 interventions) were included. Compared to blank control: 1) Combined physical intervention + analgesia/sedation (MD = − 2.7, 95% CrI: − 5.3 to − 0.15) and water perfusion/CO 2 insufflation (MD = − 1.9, 95% CrI: − 2.8 to − 0.99) significantly reduced pain; 2) Among non-pharmacological interventions, CO 2 insufflation, water perfusion, and visual distraction showed significant advantages; 3) Among pharmacological/combined interventions, pethidine + benzodiazepines + non-pharmacological (MD = − 5.1, 95% CrI: − 8.6 to − 1.7) and propofol-based strategies were most effective. SUCRA rankings identified combined physical intervention + analgesia/sedation, propofol, and water perfusion/CO 2 as top overall interventions. Conclusion: Multimodal strategies that combine pharmacological agents, especially pethidine or propofol, with non-pharmacological techniques such as CO 2 insufflation and water perfusion provide the most effective pain relief during colonoscopy. Keywords: colonoscopy, pain relief, network meta-analysis, nonpharmacologic interventions, randomized controlled trials

Source: Journal of Pain Research

DOI: 10.2147/jpr.s554665