ORIGINAL ARTICLE
Severity and duration of pain after colonoscopy and gastroscopy: a cohort study Penny Allen, Elissa Shaw, Anne Jong, Heidi Behrens and Isabelle Skinner
Aims and objectives. This study aimed to determine the prevalence, severity, location and duration of pain post-colonoscopy, and to explore possible associations between pain, demographic variables and diagnostic findings. The study also sought to provide information to guide decision-making on CO2 insufflation. Background. Colonoscopy with sedation is a common day surgery procedure in Australia. Attendance for colonoscopy is influenced by patient expectations, particularly about pain. Research on post-colonoscopy pain has focussed on pain experienced immediately post-procedure, with few studies investigating pain beyond 24 hours. Design. Follow-up study using patient-completed Pain Numerical Rating Scales. Methods. Patients undergoing colonoscopy at a single hospital day surgery unit were invited to complete Pain Numerical Rating Scales (where 0 = no pain and 10 = worst possible pain) three times daily for three days post-colonoscopy. Results. Among the 277 participants, 124 (45%) reported pain at any time during follow-up. Twenty-one (8%) participants experienced pain on each of the three days. Pain was most commonly experienced in the hypogastric and iliac regions. The severity of pain was low, with only 33 participants self-administering analgesics (paracetamol or nonsteroidal anti-inflammatory drugs) during follow-up. Participants who had both colonoscopy and gastroscopy were not more likely to report pain overall. However, they were more likely to report pain on days 2 and 3 and were also more likely to take analgesics. Pain was not associated with procedure duration, abdominal pressurisation, removal of polyps, diverticulitis, inflammatory bowel disease or the presence of benign or malignant lesions. Conclusions. This research indicates that fewer than half of the patients undergoing colonoscopy will experience post-procedure pain and that just over one in ten patients will require analgesics. Patients undergoing both gastroscopy and colonoscopy are more likely to experience pain for longer and require over-the-counter analgesics. The low prevalence of pain suggests that room air insufflation is an acceptable alternative to more expensive CO2. Relevance to clinical practice. The findings provide evidence for nurses and clinicians to advise patients about the likelihood of experiencing pain post-colonoscopy, Authors: Penny Allen, PhD, MPH, BA (Hons), Research Fellow, Rural Clinical School, The University of Tasmania, Burnie, Tasmania; Elissa Shaw, PGradCert, BN, Clinical Nurse Educator, Mersey Community Hospital, Department of Health and Human Services, LaTrobe Tasmania, Executive Member of Tasmanian Operating Room Nurses (TORN) and Director, Board of Australian College of Operating Room Nurses (ACORN); Anne Jong, GradDip, BN, Clinical Nurse Educator, Mersey Community Hospital, Department of Health and Human Services, LaTrobe, Tasmania; Heidi Behrens,
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 1895–1903, doi: 10.1111/jocn.12817
What does this paper contribute to the wider global clinical community?
• Nurses and physicians may reas-
• •
sure patients undergoing colonoscopy that fewer than half of the patients who undergo colonoscopy will experience postprocedure pain. Post-colonoscopy pain is usually mild. Patients who experience intense pain, or experience pain for longer than three days should be advised to seek medical care.
BSc (Hons), Junior Research Fellow, Rural Clinical School, The University of Tasmania, Burnie, Tasmania; Isabelle Skinner, MBA, PhD, RN RM, Professor of Nursing, Rural and Regional Practice Development, School of Health and Rural Clinical School, The University of Tasmania, Burnie, Tasmania. Correspondence: Penny Allen, Research Fellow, Rural Clinical School, The University of Tasmania, Private Bag 3513 Hospitals’ Campus, Burnie, Tas. 7320, Australia. Telephone: +61 457005954. E-mail: [email protected]
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and the characteristics of this pain. Nurses may reassure patients that pain is not more likely among patients diagnosed with colorectal disease or malignancy. Patients who have persistent pain for longer than 24 hours post-colonoscopy should be advised to seek medical care to investigate the cause of their pain.
Key words: colonoscopy, gastroscopy, pain, post-operative pain, surgery Accepted for publication: 14 February 2015
Introduction Colorectal cancer is the second most common form of cancer in Australia with a prevalence rate of approximately 495 cases per 100,000 people (Australian Institute of Health & Welfare 2012). Colorectal cancer is estimated to account for 13% of the burden of disease due to cancer for men and 12% for women (Australian Institute of Health & Welfare & Australasian Association of Cancer Registries 2012). Early detection can improve the survival rates significantly but current estimates show that only 19% of colorectal cancers are detected at stage 1 (Cole et al. 2013). Colonoscopy is the preferred modality for colorectal cancer screening following a positive faecal occult blood test (FOBT) and is also used as a diagnostic test for diverticulitis, colitis and inflammatory bowel disease (IBD). Diverticulosis is usually asymptomatic but it is estimated that 10– 25% of people with the condition will develop diverticulitis, which is characterised by bleeding and pain (Heise 2008). It can lead also to perforation of the bowel and occasionally death. Colonoscopy with sedation is a common day surgery procedure in Australia. Department of Health and Ageing data for the latest available year indicate 462,375 colonoscopies were performed in Australia during 2009–2010 (Department of Health & Ageing 2011). This number is likely to have increased in recent years and will further expand, consistent with other countries, (Phillips et al. 2007, Parente et al. 2011) as Australia implements a national (FOBT) bowel cancer screening programme. By 2017 the National Bowel Cancer Screen Program will provide biannual screening at no cost to the participant, for all persons aged between 50–74 years (Department of Health Australian Government 2014).
Background Attendance for colonoscopy is influenced by patient expectations; colonoscopy is invasive and generally considered to be
1896
a painful procedure for which patients have varying and culturally specific expectations of pain management (Ladas et al. 2010). Furthermore, endoscopic procedures are not without risk, although complications such as bleeding, bowel perforations, splenic injury, myocardial infarction and severe abdominal pain are relatively rare at
Severity and duration of pain after colonoscopy and gastroscopy: a cohort study Penny Allen, Elissa Shaw, Anne Jong, Heidi Behrens and Isabelle Skinner
Aims and objectives. This study aimed to determine the prevalence, severity, location and duration of pain post-colonoscopy, and to explore possible associations between pain, demographic variables and diagnostic findings. The study also sought to provide information to guide decision-making on CO2 insufflation. Background. Colonoscopy with sedation is a common day surgery procedure in Australia. Attendance for colonoscopy is influenced by patient expectations, particularly about pain. Research on post-colonoscopy pain has focussed on pain experienced immediately post-procedure, with few studies investigating pain beyond 24 hours. Design. Follow-up study using patient-completed Pain Numerical Rating Scales. Methods. Patients undergoing colonoscopy at a single hospital day surgery unit were invited to complete Pain Numerical Rating Scales (where 0 = no pain and 10 = worst possible pain) three times daily for three days post-colonoscopy. Results. Among the 277 participants, 124 (45%) reported pain at any time during follow-up. Twenty-one (8%) participants experienced pain on each of the three days. Pain was most commonly experienced in the hypogastric and iliac regions. The severity of pain was low, with only 33 participants self-administering analgesics (paracetamol or nonsteroidal anti-inflammatory drugs) during follow-up. Participants who had both colonoscopy and gastroscopy were not more likely to report pain overall. However, they were more likely to report pain on days 2 and 3 and were also more likely to take analgesics. Pain was not associated with procedure duration, abdominal pressurisation, removal of polyps, diverticulitis, inflammatory bowel disease or the presence of benign or malignant lesions. Conclusions. This research indicates that fewer than half of the patients undergoing colonoscopy will experience post-procedure pain and that just over one in ten patients will require analgesics. Patients undergoing both gastroscopy and colonoscopy are more likely to experience pain for longer and require over-the-counter analgesics. The low prevalence of pain suggests that room air insufflation is an acceptable alternative to more expensive CO2. Relevance to clinical practice. The findings provide evidence for nurses and clinicians to advise patients about the likelihood of experiencing pain post-colonoscopy, Authors: Penny Allen, PhD, MPH, BA (Hons), Research Fellow, Rural Clinical School, The University of Tasmania, Burnie, Tasmania; Elissa Shaw, PGradCert, BN, Clinical Nurse Educator, Mersey Community Hospital, Department of Health and Human Services, LaTrobe Tasmania, Executive Member of Tasmanian Operating Room Nurses (TORN) and Director, Board of Australian College of Operating Room Nurses (ACORN); Anne Jong, GradDip, BN, Clinical Nurse Educator, Mersey Community Hospital, Department of Health and Human Services, LaTrobe, Tasmania; Heidi Behrens,
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 1895–1903, doi: 10.1111/jocn.12817
What does this paper contribute to the wider global clinical community?
• Nurses and physicians may reas-
• •
sure patients undergoing colonoscopy that fewer than half of the patients who undergo colonoscopy will experience postprocedure pain. Post-colonoscopy pain is usually mild. Patients who experience intense pain, or experience pain for longer than three days should be advised to seek medical care.
BSc (Hons), Junior Research Fellow, Rural Clinical School, The University of Tasmania, Burnie, Tasmania; Isabelle Skinner, MBA, PhD, RN RM, Professor of Nursing, Rural and Regional Practice Development, School of Health and Rural Clinical School, The University of Tasmania, Burnie, Tasmania. Correspondence: Penny Allen, Research Fellow, Rural Clinical School, The University of Tasmania, Private Bag 3513 Hospitals’ Campus, Burnie, Tas. 7320, Australia. Telephone: +61 457005954. E-mail: [email protected]
1895
P Allen et al.
and the characteristics of this pain. Nurses may reassure patients that pain is not more likely among patients diagnosed with colorectal disease or malignancy. Patients who have persistent pain for longer than 24 hours post-colonoscopy should be advised to seek medical care to investigate the cause of their pain.
Key words: colonoscopy, gastroscopy, pain, post-operative pain, surgery Accepted for publication: 14 February 2015
Introduction Colorectal cancer is the second most common form of cancer in Australia with a prevalence rate of approximately 495 cases per 100,000 people (Australian Institute of Health & Welfare 2012). Colorectal cancer is estimated to account for 13% of the burden of disease due to cancer for men and 12% for women (Australian Institute of Health & Welfare & Australasian Association of Cancer Registries 2012). Early detection can improve the survival rates significantly but current estimates show that only 19% of colorectal cancers are detected at stage 1 (Cole et al. 2013). Colonoscopy is the preferred modality for colorectal cancer screening following a positive faecal occult blood test (FOBT) and is also used as a diagnostic test for diverticulitis, colitis and inflammatory bowel disease (IBD). Diverticulosis is usually asymptomatic but it is estimated that 10– 25% of people with the condition will develop diverticulitis, which is characterised by bleeding and pain (Heise 2008). It can lead also to perforation of the bowel and occasionally death. Colonoscopy with sedation is a common day surgery procedure in Australia. Department of Health and Ageing data for the latest available year indicate 462,375 colonoscopies were performed in Australia during 2009–2010 (Department of Health & Ageing 2011). This number is likely to have increased in recent years and will further expand, consistent with other countries, (Phillips et al. 2007, Parente et al. 2011) as Australia implements a national (FOBT) bowel cancer screening programme. By 2017 the National Bowel Cancer Screen Program will provide biannual screening at no cost to the participant, for all persons aged between 50–74 years (Department of Health Australian Government 2014).
Background Attendance for colonoscopy is influenced by patient expectations; colonoscopy is invasive and generally considered to be
1896
a painful procedure for which patients have varying and culturally specific expectations of pain management (Ladas et al. 2010). Furthermore, endoscopic procedures are not without risk, although complications such as bleeding, bowel perforations, splenic injury, myocardial infarction and severe abdominal pain are relatively rare at
