Easing the Discomfort of Colonoscopy
April 7, 2000 (Lake Worth, Fla.) -- Many people who have a colonoscopy, a
comprehensive but often painful screening test for colon cancer, complain that
they are not adequately sedated. Researchers who set out to determine whether
patients could get better results by controlling the sedation themselves found
that these patients had no less pain than those who were sedated normally.
Colonoscopy is one of several tests for colon cancer. This type of cancer
will kill approximately 56,000 people in the U.S. this year, and many of these
deaths could be avoided with early detection. According to the American Cancer
Society, early detection can increase survival by 90%, but only 37% of colon
cancers are detected early.
The study from Haifa, Israel, compared normal sedation with
patient-controlled sedation to see whether the test might be more easily
tolerated if the patients could determine when they needed more medication.
"[D]issatisfaction with the level of sedation and analgesia is
relatively common among patients undergoing colonoscopy," Edy Stermer, MD,
and her colleagues write in the March issue of Gastrointestinal
The researchers found that allowing patients to push a button and receive
more pain medication did not lead to them having any less pain overall than
patients who were given more pain medication by the doctor. Both groups of
patients used the same amount of medication. Although there was some concern
about the safety of allowing patients to give themselves more medication, both
groups tolerated the colonoscopy equally well.
Michael Pignone, MD, MPH, tells WebMD that he thinks standard sedation is
probably adequate, and that is why there was no benefit to allowing patients to
give themselves more pain medication. Pignone, an associate professor in the
division of internal medicine at the University of North Carolina in Chapel
Hill, was not a part of the Israeli study.
Colonoscopy is a 20- to 30-minute procedure in which a flexible, lighted
instrument about the diameter of an index finger is inserted into the anus to
enable the physician to examine the colon. Patients are generally awake for it,
but sedation is usually used to relieve the discomfort.
"The sedation makes one feel light-headed," Glenn Eisen, MD, MPH,
tells WebMD. Fortunately, the sedative that is used also causes amnesia,
"so the patient may well not remember the procedure," he says. Patients
having the procedure cannot be "put out" completely, as that would
require a breathing machine, Eisen says, and that carries greater risks than
the colonoscopy itself. Eisen is an associate professor of medicine and
director of endoscopy at Vanderbilt University Medical Center in Nashville,
Ever since Today Show host Katie Couric televised her own
colonoscopy, interest in the procedure has risen. However, colonoscopy isn't
the only way to screen for this disease, and it may not be needed by