Skip to main content

Advertisement

SpringerLink
Log in

Effect of visual distraction on pain in adults undergoing colonoscopy: a meta-analysis

  • Original Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Pain is a contributing factor to the low compliance rate for performing a colonoscopy on screening for colorectal cancer.

Purpose

This meta-analysis aimed to evaluate the effect of visual distraction on adults undergoing colonoscopy.

Methods

We searched PubMed, EMBASE, Web of Science, and Cochrane Library Database from their inception to February 2022. Randomized controlled trials comparing visual distraction with non-visual distraction were considered for inclusion. The fixed-effects and random-effects models were used to pool the data from individual studies and the Cochrane risk of bias assessment tool was used to determine the methodology quality.

Results

This meta-analysis included four studies (N = 301) for pain level and total procedure time, three studies (N = 181) for satisfaction score, three studies (N = 196) for anxiety level, and four studie (N = 402) for willingness to repeat the procedure. The pooled analysis shown that significantly lower pain levels (SMD, − 0.25; 95% CI − 0.47 to − 0.02; P = 0.03), higher satisfaction score with the procedure (SMD, 0.63; 95% CI, 0.33 to 0.93; P < 0.0001), and higher willingness to repeat the procedure (OR, 2.66; 95% CI 1.70 to 4.17; P < 0.0001) in the visual distraction group than those in the non-visual distraction group, with no significant differences in total procedure time (SMD,− 0.07; 95% CI − 0.30 to 0.15; P = 0.53) or anxiety level (SMD,− 0.27; 95% CI − 0.55 to 0.01; P = 0.06).

Conclusions

Visual distraction improved the patient’s pain, satisfaction, and willingness to repeat the procedure. Thus, visual stimulation is an effective way to reduce pain during colonoscopy and should be recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, Cercek A, Smith RA, Jemal A (2020) Colorectal cancer statistics, 2020. CA Cancer J Clin 70(3):145–164. https://doi.org/10.3322/caac.21601

    Article  PubMed  Google Scholar 

  2. Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK (2021) ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol 116(3):458–479. https://doi.org/10.14309/ajg.0000000000001122

    Article  PubMed  Google Scholar 

  3. Montminy EM, Jang A, Conner M, Karlitz JJ (2020) Screening for colorectal cancer. Med Clin North Am 104(6):1023–1036. https://doi.org/10.1016/j.mcna.2020.08.004

    Article  PubMed  Google Scholar 

  4. Bynum SA, Davis JL, Green BL, Katz RV (2012) Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. Am J Health Promot 26(5):295–300. https://doi.org/10.4278/ajhp.110113-QUAN-20

    Article  PubMed  Google Scholar 

  5. Ghevariya V, Duddempudi S, Ghevariya N, Reddy M, Anand S (2013) Barriers to screening colonoscopy in an urban population: a study to help focus further efforts to attain full compliance. Int J Colorectal Dis 28(11):1497–1503. https://doi.org/10.1007/s00384-013-1708-7

    Article  PubMed  Google Scholar 

  6. Trevisani L, Zelante A, Sartori S (2014) Colonoscopy, pain and fears: Is it an indissoluble trinomial? World J Gastrointest Endosc 6(6):227–233. https://doi.org/10.4253/wjge.v6.i6.227

    Article  PubMed  PubMed Central  Google Scholar 

  7. Childers RE, Williams JL, Sonnenberg A (2015) Practice patterns of sedation for colonoscopy. Gastrointest Endosc 82(3):503–511. https://doi.org/10.1016/j.gie.2015.01.041

    Article  PubMed  PubMed Central  Google Scholar 

  8. Trummel JM, Chandrasekhara V, Kochman ML (2017) Anesthesia for colonoscopy and lower endoscopic procedures. Anesthesiol Clin 35(4):679–686. https://doi.org/10.1016/j.anclin.2017.08.007

    Article  PubMed  Google Scholar 

  9. Lin OS (2017) Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction. Intest Res 15(4):456–466. https://doi.org/10.5217/ir.2017.15.4.456

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wernli KJ, Brenner AT, Rutter CM, Inadomi JM (2016) Risks associated with anesthesia services during colonoscopy. Gastroenterology 150(4):888–894. https://doi.org/10.1053/j.gastro.2015.12.018

    Article  PubMed  Google Scholar 

  11. Bani Mohammad E, Ahmad M (2019) Virtual reality as a distraction technique for pain and anxiety among patients with breast cancer: a randomized control trial. Palliat Support Care 17(1):29–34. https://doi.org/10.1017/S1478951518000639

    Article  PubMed  Google Scholar 

  12. Koticha P, Katge F, Shetty S, Patil DP (2019) Effectiveness of virtual reality eyeglasses as a distraction aid to reduce anxiety among 6–10-year-old children undergoing dental extraction procedure. Int J Clin Pediatr Dent 12(4):297–302. https://doi.org/10.5005/jp-journals-10005-1640

    Article  PubMed  PubMed Central  Google Scholar 

  13. Matheve T, Bogaerts K, Timmermans A (2020) Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: a randomized controlled trial. J Neuroeng Rehabil 17(1):55. https://doi.org/10.1186/s12984-020-00688-0

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sajeev MF, Kelada L, Yahya Nur AB, Wakefield CE, Wewege MA, Karpelowsky J, Akimana B, Darlington AS, Signorelli C (2021) Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis. Br J Anaesth 127(4):608–619. https://doi.org/10.1016/j.bja.2021.06.039

    Article  PubMed  Google Scholar 

  15. Celebi D, Yilmaz E, Sahin ST, Baydur H (2020) The effect of music therapy during colonoscopy on pain, anxiety and patient comfort: a randomized controlled trial. Complement Ther Clin Pract 38:101084. https://doi.org/10.1016/j.ctcp.2019.101084

    Article  PubMed  Google Scholar 

  16. De Silva AP, Niriella MA, Nandamuni Y, Nanayakkara SD, Perera KRP, Kodisinghe SK, Subasinghe KCE, Pathmeswaran A, de Silva HJ. (2016). Effect of audio and visual distraction on patients undergoing colonoscopy: a randomized controlled study. Endoscopy international open, 4(11) E1211-E1214. <Go to ISI>://MEDLINE:27853748

  17. Bechtold ML, Puli SR, Othman MO, Bartalos CR, Marshall JB, Roy PK (2009) Effect of music on patients undergoing colonoscopy: a meta-analysis of randomized controlled trials. Dig Dis Sci 54(1):19–24. https://doi.org/10.1007/s10620-008-0312-0

    Article  PubMed  Google Scholar 

  18. Sorkpor SK, Johnson CM, Santa Maria DM, Miao H, Moore C, Ahn H (2021) The effect of music listening on pain in adults undergoing colonoscopy: a systematic review and meta-analysis. J Perianesth Nurs 36(5):573-580 e571. https://doi.org/10.1016/j.jopan.2020.12.012

    Article  PubMed  Google Scholar 

  19. Tam WW, Wong EL, Twinn SF (2008) Effect of music on procedure time and sedation during colonoscopy: a meta-analysis. World J Gastroenterol 14(34):5336–5343. https://doi.org/10.3748/wjg.14.5336

    Article  PubMed  PubMed Central  Google Scholar 

  20. Indovina P, Barone D, Gallo L, Chirico A, De Pietro G, Giordano A (2018) Virtual reality as a distraction intervention to relieve pain and distress during medical procedures: a comprehensive literature review. Clin J Pain 34(9):858–877. https://doi.org/10.1097/ajp.0000000000000599

    Article  PubMed  Google Scholar 

  21. Jiang XL, Li XL, Lan ZH (2015) Effects of visual and audiovisual distraction on pain and anxiety among patients undergoing colonoscopy. Gastroenterol Nurs 38(1):55–61. https://doi.org/10.1097/sga.0000000000000089

    Article  Google Scholar 

  22. Lee DW, Chan AC, Wong SK, Fung TM, Li AC, Chan SK, Mui LM, Ng EK, Chung SC (2004) Can visual distraction decrease the dose of patient-controlled sedation required during colonoscopy? a prospective randomized controlled trial. Endoscopy 36(3):197–201. https://doi.org/10.1055/s-2004-814247

    Article  CAS  PubMed  Google Scholar 

  23. Sheng LP, Han CQ, Nie C, Xu T, Zhang K, Li XJ, Xie XR, Lin R, Ding Z (2021) Watching videos of colonoscopies and receiving interpretations reduce pain and anxiety while increasing the satisfaction of patients. Dig Dis Sci 66(2):541–546. https://doi.org/10.1007/s10620-020-06186-6

    Article  PubMed  Google Scholar 

  24. Umezawa S, Higurashi T, Uchiyama S, Sakai E, Ohkubo H, Endo H, Nonaka T, Nakajima A (2015) Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction. World J Gastroenterol 21(15):4707–4714. https://doi.org/10.3748/wjg.v21.i15.4707

    Article  PubMed  PubMed Central  Google Scholar 

  25. Veldhuijzen G, Klaassen NJM, Van Wezel RJA, Drenth JPH, Van Esch AA (2020) Virtual reality distraction for patients to relieve pain and discomfort during colonoscopy. Endosc Int Open 8(7):E959–E966. https://doi.org/10.1055/a-1178-9289

    Article  PubMed  PubMed Central  Google Scholar 

  26. Higgins JPT, TJ, Chandler J, Cumpston MLiT, Page MJ, et al. (2022). Cochrane handbook for systematic reviews of interventions version 6.3 (updated Feb 2022). www.training.cochrane.org/handbook.

  27. Barry MJ, Davidson K, Mangione CM (2021) US preventive services task force recommendation statement on screening for colorectal cancer-reply. JAMA 326(13):1328–1329. https://doi.org/10.1001/jama.2021.13469

    Article  PubMed  Google Scholar 

  28. Davis JL, Bynum SA, Katz RV, Buchanan K, Green BL (2012) Sociodemographic differences in fears and mistrust contributing to unwillingness to participate in cancer screenings. J Health Care Poor Underserved 23(4):67–76. https://doi.org/10.1353/hpu.2012.0148

    Article  PubMed  PubMed Central  Google Scholar 

  29. McLachlan SA, Clements A, Austoker J (2012) Patients’ experiences and reported barriers to colonoscopy in the screening context–a systematic review of the literature. Patient Educ Couns 86(2):137–146. https://doi.org/10.1016/j.pec.2011.04.010

    Article  PubMed  Google Scholar 

  30. Ladas SD, Satake Y, Mostafa I, Morse J (2010) Sedation practices for gastrointestinal endoscopy in Europe, North America, Asia Africa and Australia. Digestion 82(2):74–76. https://doi.org/10.1159/000285248

    Article  PubMed  Google Scholar 

  31. Zhou S, Zhu Z, Dai W, Qi S, Tian W, Zhang Y, Zhang X, Huang L, Tian J, Yu W, Su D (2021) National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals. Br J Anaesth 127(1):56–64. https://doi.org/10.1016/j.bja.2021.01.028

    Article  CAS  PubMed  Google Scholar 

  32. Sato M, Horiuchi A, Tamaki M, Ichise Y, Kajiyama M, Yamamoto Y, Tanaka N (2019) Safety and effectiveness of nurse-administered propofol sedation in outpatients undergoing gastrointestinal endoscopy. Clin Gastroenterol Hepatol 17(6):1098-1104.e1091. https://doi.org/10.1016/j.cgh.2018.06.025

    Article  PubMed  Google Scholar 

  33. Zacharias P, Mathew S, Mathews J, Somu A, Peethambaran M, Prashanth M, Philip M (2018) Sedation practices in gastrointestinal endoscopy-a survey from southern India. Indian J Gastroenterol 37(2):164–168. https://doi.org/10.1007/s12664-018-0843-z

    Article  PubMed  Google Scholar 

  34. Ampuero J, Romero-Gomez M (2012) Re: unsedated colonoscopy: an option for some but not for all. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2012.03.003

    Article  PubMed  Google Scholar 

  35. Cakir SK, Evirgen S (2021) The effect of virtual reality on pain and anxiety during colonoscopy: a randomized controlled trial. Turkish Journal of Gastroenterology 32(5):451–457. https://doi.org/10.5152/tjg.2021.191081

    Article  Google Scholar 

  36. Basak T, Duman S, Demirtas A (2020) Distraction-based relief of pain associated with peripheral intravenous catheterisation in adults: a randomised controlled trial. J Clin Nurs 29(5–6):770–777. https://doi.org/10.1111/jocn.15131

    Article  PubMed  Google Scholar 

  37. Grabinski ZG, Boscamp NS, Zuckerman WA, Zviti R, O’Brien A, Martinez M, Tsze DS (2022) Efficacy of distraction for reducing pain and distress associated with venipuncture in the pediatric posttransplant population: a randomized controlled trial. Pediatr Emerg Care 38(2):e811–e815. https://doi.org/10.1097/PEC.0000000000002458

    Article  PubMed  Google Scholar 

  38. Molleman J, Tielemans JF, Braam MJI, Weitenberg B, Koch R (2019) Distraction as a simple and effective method to reduce pain during local anesthesia: a randomized controlled trial. J Plast Reconstr Aesthet Surg 72(12):1979–1985. https://doi.org/10.1016/j.bjps.2019.07.023

    Article  PubMed  Google Scholar 

  39. Malloy KM, Milling LS (2010) The effectiveness of virtual reality distraction for pain reduction: a systematic review. Clin Psychol Rev 30(8):1011–1018. https://doi.org/10.1016/j.cpr.2010.07.001

    Article  PubMed  Google Scholar 

  40. Houze B, Streff A, Piche M, Rainville P (2021) Spinal and supraspinal modulation of pain responses by hypnosis, suggestions, and distraction. Am J Clin Hypn 63(4):329–354. https://doi.org/10.1080/00029157.2020.1863184

    Article  PubMed  Google Scholar 

  41. Canbulat Sahiner N, Turkmen AS (2019) The effect of distraction cards on reducing pain and anxiety during intramuscular injection in children. Worldviews Evid Based Nurs 16(3):230–235. https://doi.org/10.1111/wvn.12359

    Article  PubMed  Google Scholar 

  42. Johnson MH (2005) How does distraction work in the management of pain? Curr Pain Headache Rep 9(2):90–95. https://doi.org/10.1007/s11916-005-0044-1

    Article  PubMed  Google Scholar 

  43. Wittkopf PG, Lloyd DM, Coe O, Yacoobali S, Billington J (2020) The effect of interactive virtual reality on pain perception: a systematic review of clinical studies. Disabil Rehabil 42(26):3722–3733. https://doi.org/10.1080/09638288.2019.1610803

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia

    Yuan-Yuan Zhang, Ramoo Vimala & Ping Lei Chui

  2. School of Medical and Health Engineering, Changzhou University, Changzhou, 213000, Jiangsu, China

    Yuan-Yuan Zhang

  3. Faculty of Nursing, Universitas Airlangga, Surabaya, 60132, Indonesia

    Ramoo Vimala

  4. Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia

    Ida Normiha Hilmi

Authors
  1. Yuan-Yuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ramoo Vimala
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ping Lei Chui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ida Normiha Hilmi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ramoo Vimala.

Ethics declarations

Disclosures

Yuan-Yuan Zhang, Ramoo Vimala, Ping Lei Chui, Ida Normiha Hilmi have no conflicts of interest or financial ties to disclose.

Ethical approval

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, YY., Vimala, R., Chui, P.L. et al. Effect of visual distraction on pain in adults undergoing colonoscopy: a meta-analysis. Surg Endosc 37, 2633–2643 (2023). https://doi.org/10.1007/s00464-022-09724-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09724-7

Keywords

Search

Navigation