Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction.
OBJECTIVE
To evaluate the effect of a relaxing visual distraction alone on patient pain, anxiety, and satisfaction during colonoscopy.


METHODS
This study was designed as an endoscopist-blinded randomized controlled trial with 60 consecutively enrolled patients who underwent elective colonoscopy at Yokohama City University Hospital, Japan. Patients were randomly assigned to two groups: group 1 watched a silent movie using a head-mounted display, while group 2 only wore the display. All of the colonoscopies were performed without sedation. We examined pain, anxiety, and the satisfaction of patients before and after the procedure using questionnaires that included the Visual Analog Scale. Patients were also asked whether they would be willing to use the same method for a repeat procedure.


RESULTS
A total of 60 patients were allocated to two groups. Two patients assigned to group 1 and one patient assigned to group 2 were excluded after the randomization. Twenty-eight patients in group 1 and 29 patients in group 2 were entered into the final analysis. The groups were similar in terms of gender, age, history of prior colonoscopy, and pre-procedural anxiety score. The two groups were comparable in terms of the cecal insertion rate, the time to reach the cecum, the time needed for the total procedure, and vital signs. The median anxiety score during the colonoscopy did not differ significantly between the two groups (median scores, 20 vs 24). The median pain score during the procedure was lower in group 1, but the difference was not significant (median scores, 24.5 vs 42). The patients in group 1 reported significantly higher median post-procedural satisfaction levels, compared with the patients in group 2 (median scores, 89 vs 72, P = 0.04). Nearly three-quarters of the patients in group 1 wished to use the same method for repeat procedures, and the difference in rates between the two groups was statistically significant (75.0% vs 48.3%, P = 0.04). Patients with greater levels of anxiety before the procedure tended to feel a painful sensation. Among patients with a pre-procedural anxiety score of 50 or higher, the anxiety score during the procedure was significantly lower in the group that received the visual distraction (median scores, 20 vs 68, P = 0.05); the pain score during the colonoscopy was also lower (median scores, 23 vs 57, P = 0.04). No adverse effects arising from the visual distraction were recognized.


CONCLUSIONS
Visual distraction alone improves satisfaction in patients undergoing colonoscopy and decreases anxiety and pain during the procedure among patients with a high pre-procedural anxiety score.
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 2360004, Japan.
Shotaro
S
Umezawa
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 2360004, Japan.
Takuma
T
Higurashi
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 2360004, Japan.
Shiori
S
Uchiyama
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 2360004, Japan.
Eiji
E
Sakai
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 2360004, Japan.
Hidenori
H
Ohkubo
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 2360004, Japan.
Hiroki
H
Endo
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 2360004, Japan.
Takashi
T
Nonaka
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 2360004, Japan.
Atsushi
A
Nakajima
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000517:prevention & control / Q000523:psychology; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009040:Motion Pictures; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D010147:Pain Measurement; D058748:Pain Perception; D017060:Patient Satisfaction; D010775:Photic Stimulation; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires; D013997:Time Factors; D014796:Visual Perception
Anesthesia; Colonoscopy; Colorectal cancer screening; Patient satisfaction; Photic stimulation