Comparative Effectiveness of Pharmacological, Non-Pharmacological, and Combined Strategies for Pain Relief During Colonoscopy: A Bayesian Network Meta-Analysis of Randomized Trials.

BACKGROUND

Colonoscopy is the gold standard for colorectal cancer screening, but procedural pain remains a major barrier to patient compliance. Various pharmacological and non-pharmacological interventions have been developed to improve patient comfort, yet the comparative effectiveness of these strategies remains unclear.

METHODS

We systematically searched five databases for randomized controlled trials published between 2004 and 2024 that evaluated analgesic interventions for colonoscopy and performed a Bayesian random-effects network meta-analysis. We analyzed two pre-specified subnetworks-non-pharmacological and pharmacological/combined-according to intervention type. The primary outcome was pain on a visual analogue scale.

RESULTS

40 RCTs (5614 participants, 32 interventions) were included. Compared to blank control: 1) Combined physical intervention + analgesia/sedation (MD = -2.7, 95% CrI: -5.3 to -0.15) and water perfusion/CO2 insufflation (MD = -1.9, 95% CrI: -2.8 to -0.99) significantly reduced pain; 2) Among non-pharmacological interventions, CO2 insufflation, water perfusion, and visual distraction showed significant advantages; 3) Among pharmacological/combined interventions, pethidine + benzodiazepines + non-pharmacological (MD = -5.1, 95% CrI: -8.6 to -1.7) and propofol-based strategies were most effective. SUCRA rankings identified combined physical intervention + analgesia/sedation, propofol, and water perfusion/CO2 as top overall interventions.

CONCLUSION

Multimodal strategies that combine pharmacological agents, especially pethidine or propofol, with non-pharmacological techniques such as CO2 insufflation and water perfusion provide the most effective pain relief during colonoscopy.