title: Medication-free colonoscopy--factors related to pain and its assessment.
abstract: OBJECTIVE
  This paper is a report of a study conducted to determine the possibility of performing colonoscopy without medication, elucidate the factors related to a painful colonoscopy experience and compare colonoscopy patients' reported pain assessment to nurses' and endoscopists' observations.
  
  
  BACKGROUND
  Sedation and pain medication are routinely administered for colonoscopies in many countries. However, medication-free colonoscopies have attracted attention because the use of medication requires a time commitment from patients and increases complications. Earlier studies show that, for instance, gender, age and pelvic operations may increase the risk of painful colonoscopy and those healthcare professionals and patients appear to assess pain differently.
  
  
  METHODS
  A cross-sectional descriptive study was conducted in a Finnish university hospital using questionnaires developed for this study and analysed statistically. The sample of 138 colonoscopy patients, 11 nurses and 11 endoscopists was recruited in 2006.
  
  
  RESULTS
  Over three-quarters of patients reported mild pain or no pain at all. Patients' nervousness is a risk factor for experiencing pain during colonoscopy. Both nurses and endoscopists slightly underestimated the intensity of pain experienced by patients.
  
  
  CONCLUSIONS
  It is possible to perform colonoscopy without medication with most patients and focus sedation and pain medication on at-risk patients, especially those who are nervous. Before the procedure, nurses must devote time to discovering which patients are nervous and at risk of having a painful colonoscopy to present them for sedation. To improve pain management for patients having colonoscopy, endoscopists and nurses should participate systematically in pain education and use pain scales.
authors.affiliation: Department of Nursing Science, University of Kuopio, Kuopio, Finland. eeva-riitta.ylinen@pp.inet.fi
authors.forename: Eeva-Riitta
authors.initials: ER
authors.lastname: Ylinen
authors.forename: Katri
authors.initials: K
authors.lastname: Vehviläinen-Julkunen
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Pietilä
authors.forename: Marja-Leena
authors.initials: ML
authors.lastname: Hannila
authors.forename: Markku
authors.initials: M
authors.lastname: Heikkinen
mesh_terms: D002983:Clinical Competence / Q000592:standards; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D016292:Procedural Sedation; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D010146:Pain / Q000209:etiology / Q000523:psychology; D010147:Pain Measurement / Q000451:nursing / Q000592:standards; D017060:Patient Satisfaction