Pain perception during colonoscopy in relation to gender and equipment: a clinical study

Objectives A trend for gender-related differences in pain perception during colonoscopies has previously been observed. No consecutive clinical studies have been conducted to confirm such a relation. We aimed to investigate gender-related differences during the colonoscopy procedure, and the impact of endoscopic equipment and psychological factors on pain management. Methods In a consecutive clinical study, 391 patients referred for colonoscopy reported pain perception on a 0-10 visual analogue scale (VAS) after the procedure. A sub-group of patients (n=38) were given alternate instructions expertly tailored by a psychologist and their VAS scores were compared with those from the main study population. Data from a previous study from the same specialist practice and same source patient population using previous-generation equipment was included for comparison. Results No overall gender-related difference in VAS reports was found. There was no reduction in VAS when alternate instructions were given. Female patients were, however, more likely to benefit from light sedation (p=0.012). When compared with previous-generation endoscopes, the current generation equipment resulted in a VAS drop of 1.9 points for women and 1.6 for men (p<0.009) and washed out a previously observed gender-related difference. Conclusion No overall gender-related differences were found for pain experience during the colonoscopy procedure. Access to up-to-date endoscopic equipment can reduce procedure-related patient discomfort considerably, even at the expert level of a consultant physician. Implications Gastroenterologists should consider utilizing high-end endoscopic equipment to improve pain management and reduce VAS to very acceptable levels.